Distance, Use of Resources, and Mortality Among Rural Missouri Residents With Acute Myocardial Infarction

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Abstract
Prompt access to medical services is considered critical in managing acute myocardial infarction (AMI). Several socioeconomic and geographic factors affect access to such care in rural areas. This study measured the effect of geographic distance from care on utilization of cardiovascular technology and death after AMI. The records of 1,658 rural Missouri residents age 65 or older with a discharge diagnosis of AMI in 1991 were obtained from Medicare data. The rate of use of cardiovascular technology and rate of post‐AMI mortality for rural Missouri residents who live far from emergency departments and cardiac referral centers (CRC) were compared with those who live nearest such services. Those living 60 miles or more from a CRC were less likely to have cardiac catheterization (odds ratio [OR]=0.55; 95% confidence interval [CI]=0.40 to 0.75) or angioplasty (OR=0.68; 95% CI=0.47 to 0.98), compared with those living fewer than 30 miles from a CRC. There were no differences in 30‐day, 90‐day, or one‐year mortality rates. After adjusting for distance to a CRC, those living 20 miles or more from emergency services were more likely to have coronary artery bypass grafting (OR=1.92; 95% CI=1.18 to 3.15) than those living fewer than 10 miles from such services, but there was no difference in mortality. Distance from services strongly predicts utilization of cardiovascular resources, but it does not predict mortality among rural Missouri Medicare beneficiaries hospitalized with AMI.