Lin Anthony L, Allen Kelli, Gutierrez Jorge A, Piccini Jonathan P, Loring Zak
Division of Cardiology, Department of Medicine Duke University Health System Durham NC USA.
Durham Veterans Affairs Medical Center Durham NC USA.
J Am Heart Assoc. 2025 Mar 4;14(5):e036899. doi: 10.1161/JAHA.124.036899. Epub 2025 Mar 3.
Atrial fibrillation (AF) is the most common sustained arrhythmia and associated with increased morbidity and mortality. Differences have been identified between medical care delivered in urban and rural settings, and rurality-based disparities may exist in AF care. We performed a systematic review investigating the effect of rurality on AF care and outcomes in the United States. PubMed was queried for entries on AF and rurality: ("atrial fibrillation" OR "atrial flutter") AND ("rural" OR "urban" OR "rurality" OR "metro" OR "metropolitan") AND ("united states" OR "US" OR "U.S.") published up to September 24, 2023. Anticoagulation, rhythm control, settings of care, outcomes, and all-cause mortality were reviewed in relevant studies. The search identified 395 total articles. After screening, 14 relevant articles were included in the review. These studies ranged from 1993 to 2020 and analyzed approximately 41.7 million AF patient encounters. The use of catheter ablation for AF per electrophysiologist was similar across the rural-urban spectrum. Patients with AF and rural residence were less likely to receive a direct oral anticoagulant and more likely to remain on warfarin (relative risk, 0.90 [95% CI, 0.88-0.92]). Patients in rural communities were less likely to receive non-emergent AF care (odds ratio [OR], 0.96 [95% CI, 0.93-0.98]). In-hospital mortality for patients with AF admitted to rural hospitals was higher than urban hospitals (OR, 1.19 [95% CI, 1.01-1.39)]. Measurable differences exist in both treatments and outcomes of patients with AF between rural and urban settings in the United States. These differences should inform future investigations and strategies to improve health in people with AF.
心房颤动（AF）是最常见的持续性心律失常，与发病率和死亡率增加相关。已发现城乡医疗服务存在差异，房颤护理中可能存在基于农村地区的差异。我们进行了一项系统综述，调查美国农村地区对房颤护理和结局的影响。在PubMed上查询了关于房颤和农村地区的条目：（“心房颤动”或“心房扑动”）以及（“农村”或“城市”或“农村地区”或“大都市”或“大都会”）以及（“美国”或“US”或“U.S.”），截至2023年9月24日发表的文献。对相关研究中的抗凝治疗、节律控制、护理环境、结局和全因死亡率进行了综述。检索共识别出395篇文章。筛选后，14篇相关文章纳入综述。这些研究时间跨度从1993年至2020年，分析了约4170万例房颤患者就诊情况。每个电生理学家对房颤使用导管消融术的情况在城乡范围内相似。居住在农村的房颤患者接受直接口服抗凝剂的可能性较小，而更可能继续使用华法林（相对风险，0.90 [95% CI，0.88 - 0.92]）。农村社区的患者接受非紧急房颤护理的可能性较小（比值比[OR]，0.96 [95% CI，0.93 - 0.98]）。入住农村医院的房颤患者的院内死亡率高于城市医院（OR，1.19 [95% CI，1.01 - 1.39]）。在美国，城乡环境中房颤患者的治疗和结局均存在可测量的差异。这些差异应为未来改善房颤患者健康的调查和策略提供参考。
