Rural hospital mortality for myocardial infarction in Medicare patients in Illinois.

OBJECTIVE

To compare rural and nonrural hospitals for mortality for Medicare patients with myocardial infarction.

DESIGN

A retrospective analysis of variance from Illinois for the year 1989. Claims were aggregated by hospital and the hospitals grouped into geographic areas that were completely rural (N = 32), partially rural with small cities (N = 82), exurban (N = 21), suburban (N = 43), and urban (N = 44).

PATIENTS

11,753 patients older than 65 years hospitalized for acute myocardial infarction.

RESULTS

In rural hospitals, the mean in-hospital mortality rate was 24.3% compared to rates of 18.3-20.9% at hospitals in the other four regions (P = 0.10, power = 0.68). Rates for coronary angiography were 0% at rural hospitals compared to 8-20% at hospitals in the other four regions (P < 0 0.0005, power = 0.99).

CONCLUSION

There is a trend toward higher in-hospital mortality for myocardial infarction at rural hospitals. Whether this is caused by their inability to perform coronary angiography during the index admission warrants further investigation.