Background Evidence of health disparities between urban and rural populations usually favors urban dwellers. The impact of rurality on heart failure (HF) outcomes is unknown. Objective We compared event-free survival between HF patients living in urban and rural areas. Methods In this longitudinal study, 136 patients with HF (male, 70%; age, mean ± SD 61 ± 11 years; New York Heart Association class III/IV, 60%) were enrolled. Patients' emergency department visits for HF exacerbation and rehospitalization during follow-up were identified. Rural status was determined by rural-urban commuting area code. Survival analysis was used to determine the effect of rurality on outcomes while controlling for relevant demographic, clinical, and psychosocial variables. Results Rural patients (64%) had longer event-free survival than urban patients (P =.015). Rurality (P =.04) predicted event-free survival after controlling for age, marital status, New York Heart Association class, medications, adherence to medications, depressive symptoms, and social support. Conclusions Rural patients were less likely than their urban counterparts to experience an event. Further research is needed to identify protective factors that may be unique to rural settings.

Original languageEnglish
Pages (from-to)512-520
Number of pages9
JournalHeart and Lung: Journal of Acute and Critical Care
Issue number6
StatePublished - Dec 1 2010

Bibliographical note

Funding Information:
This study was supported by a Philips Medical-American Association of Critical Care Nurses Outcomes Grant , an American Heart Association Great River Affiliate Postdoctoral Fellowship to J.-R.W., University of Kentucky General Clinical Research Center grant M01RR02602 , grant R01 NR008567 from the National Institute of Nursing Research , and Center Grant 1P20NR010679 to the College of Nursing at the University of Kentucky from the National Institutes of Health (NIH) and National Institute of Nursing Research . The content of this article is solely the responsibility of the authors, and does not necessarily represent the official views of the National Institute of Nursing Research or the NIH.

Publisher Copyright:
© 2010 Published by Mosby, Inc.

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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