Rural Hospitalization Linked to Differences in Heart Failure Care and Outcomes

This retrospective cohort study included 735,460 Medicare beneficiaries discharged alive after hospitalization for heart failure with reduced ejection fraction (HFrEF) at US hospitals from 2013 through 2021. Patients were grouped according to their own rural or urban residence and the rurality of the hospital. The primary outcome was 90-day all-cause mortality; secondary outcomes included cardiology consultation, postdischarge guideline-directed medical therapy (GDMT) use, and heart failure readmission.

Compared with rural patients treated at rural hospitals, rural patients treated at urban hospitals were more likely to receive inpatient cardiology consultation (odds ratio [OR], 2.02) and to initiate several GDMT classes, including SGLT2 inhibitors (OR, 1.48). They also had lower one-year heart failure readmission (OR, 0.85) and mortality (OR, 0.91). Compared with urban patients treated at urban hospitals, rural patients treated at urban hospitals had higher early mortality (30-day OR, 1.10; 90-day OR, 1.05), despite lower one-year heart failure readmission (OR, 0.81).

The findings associate hospital rurality with differences in treatment and mortality, while rural residence was associated with mortality differences even at urban hospitals. The observational design cannot establish causation; the results point to disparities in care and outcomes rather than demonstrating that a particular intervention would improve them.