Differential patterns of urban and rural cardiovascular emergency department utilization and clinical outcomes

Background Rural-urban disparities in health care are prevalent in the United States. Our aim was to identify patterns in patient characteristics and outcomes of emergency department (ED) visits for five cardiovascular disease (CVD) diagnoses: myocardial infarction, heart failure, hypertension, atrial fibrillation, and stroke. Methods ED visits were identified in the 2016–2020 Nebraska (NE)-State Emergency Department Database and NE-State Inpatient Database. ED visits were stratified by patient urbanicity defined by Rural Urban Continuum Codes (Urban: 1–3, Micropolitan: 4–7, Rural: 8–9). Outcomes (inpatient mortality, length of stay, cost, 30- and 90-day ED revisits) were assessed via multivariable logistic regression and lognormal models adjusting for type of CVD, comorbidity burden via Charlson Comorbidity Index, age, sex, insurance, and income. Results There were 47,369 ED visits for CVD. Urban patients were younger, had more private insurance, and were more commonly in the highest income quartile. Transfers were more common for rural and micropolitan patients. For patients admitted to the presenting hospital, micropolitan and rural patients had 60 and 97% greater adjusted odds of inpatient mortality compared to urban patients. Similarly, micropolitan patients had 10% increased cost, and rural patients had 13% increased cost. Micropolitan patients had 18 and 15% lower odds of a 30- and 90-day revisit, whereas rural patients had 25 and 40% lower odds of a 30- and 90-day revisit compared to urban patients. Conclusion ED visits for CVD had significant urban-rural variation in patient characteristics, cost, revisit rate, and mortality. A disparity in cardiovascular outcomes exists in more rural areas of NE. These findings warrant further investigation and may inform population health initiatives.