Sex-specific trends in incidence and mortality for urban and rural ambulatory heart failure patients in Eastern Ontario from 1994-2013
Sun LY, Tu JV, Sherrard H, Rodger N, Coutinho T, Turek M, Chan E, Tulloch H, McDonnell L, Mielniczuk LM. J Card Fail. 2018; Aug 10 [Epub ahead of print].
Background — Differences in outcomes have previously been reported between urban and rural settings across a multitude of chronic diseases. Whether these discrepancies have changed over time, and how sex may influence these findings is unknown in ambulatory heart failure (HF) patients. We examined the temporal incidence and mortality trends by geography in these patients.
Methods and Results — We conducted a retrospective cohort study in 36,175 Eastern Ontario residents who were diagnosed with HF in an outpatient setting between 1994-2013. Primary outcome was one-year mortality. We examined temporal changes in mortality risk factors using multivariable Cox proportional hazard models. The incidence of HF decreased in women and men across both rural and urban settings. Age standardized mortality rates also decreased over time in both sexes but remained greater in rural men compared to rural women.
Conclusions — The incidence of HF in the ambulatory setting was greater for men than women and greater in rural than urban areas, but mortality rates remained higher in rural men than in rural women. Further research should focus on ways to reduce this gap in the outcomes of men and women with HF.