Rural and urban outcomes after hospitalization for congestive heart failure in Alberta, Canada.

OBJECTIVES

We compare the hospitalization rate, duration, cost, and mortality for newly diagnosed congestive heart failure in patients admitted to rural and metropolitan hospitals in one Canadian province.

METHODS

Administrative data for Alberta, Canada, from April 1, 1994, to March 31, 2000.

RESULTS

Hospitalizations (16,162) for newly diagnosed congestive heart failure constituted 50% of all hospitalizations for congestive heart failure. Hospitals were distributed as follows: rural with less than 200 cases (21% of hospitalizations), rural with 204 to 646 cases (21% of hospitalizations), regional (13% of hospitalizations), metropolitan with angiography capability (24% of hospitalizations), and metropolitan without angiography capability (21% of hospitalizations). The hospitalization rate per 1000 population was lower for residents of metropolitan regions (1.01; 95% confidence interval [CI] 0.97 to 1.05) compared with residents of rural (1.70; 95% CI 1.65 to 1.75) and regional (1.95; 95% CI 1.90 to 2.00) health regions. Patient comorbidity and severity scores were lower in rural hospitals. Special care unit admissions and cardiac catheterizations were more frequent in patients admitted to metropolitan hospitals. After adjustment, the length of stay and mortality were similar amongst all hospital types. Adjusted hospital total costs were about 23% (900 Canadian dollars) greater in metropolitan hospitals with angiography capability compared to rural hospitals.

CONCLUSION

Hospital admission rates for newly diagnosed congestive heart failure were lower for metropolitan residents compared to non-metropolitan residents. Cost per admission was greatest in metropolitan hospitals with angiography capability compared to other hospital types.