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Doctors & patients are saying about 'Beat Your A-Fib'...

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Atrial Fibrillation Hospitalizations: Urban-Rural Differences in Mortality Rates

A new study suggests U.S. patients hospitalized for atrial fibrillation in rural areas may be more likely to die than those hospitalized in urban areas. 

In-hospital mortality was defined as death due to any cause during hospitalization.

Researchers examined nationwide information on 248,731 adults hospitalized for atrial fibrillation between 2012 and 2014. Mean age was 69 years; 78% white; 48% women. Of these, 218,946 (88%) were from urban hospitals and 29,785 (12%) were from rural hospitals.

Study Results: Urban vs. Rural

Patients admitted to rural hospitals had a 17% increased risk of death as compared with those admitted to urban hospitals. (Around 1.3 percent of atrial fibrillation patients died in rural hospitals, compared and 1 percent in urban facilities.) The study accounted for differences in patient characteristics including high blood pressure, diabetes, heart failure and kidney damage.

“…appropriate anticoagulation and…advanced options such as ablation, are lower in rural than urban settings.” Dr. Thomas Deering

According to lead study author Dr. Wesley O’Neal of Emory University School of Medicine: “Presumably, a higher risk of death in patients from rural regions was related to differences in practice patterns and access to specialists.” 

From a related editorial: “There is also some limited data suggesting that several atrial fibrillation outcomes, for example appropriate anticoagulation usage and appropriate referral for advanced procedural options such as ablation, are lower in rural than urban settings,” wrote Dr. Thomas Deering of Piedmont Heart Institute in Atlanta.

This study examination wasn’t a controlled experiment. Further research is needed to understand these findings.

What This Means to A-Fib Patients

Atrial Fibrillation is not a one-size fits all type of disease. Don’t choose your Atrial Fibrillation healthcare provider just because their office is nearby with local hospital privileges.

When seeking treatment for your Atrial Fibrillation, your first step is to see a heart rhythm specialist (a cardiac electrophysiologist) who specializes in the electrical function of the heart (and the best you can afford). You may need to travel, but it may be worth it to you for your peace of mind.

For more see Finding the Right Doctor for You and Your A-Fib and the Directory of Doctors Treating A-Fib: Medical Centers and Practices.

Resources for this Article
O’Neal, W.T., et al. Urban-rural differences in mortality for atrial fibrillation hospitalizations in the United States. Heart Rhythm online December 10, 2017. DOI:

Rapaport, L. Atrial fibrillation more deadly in rural U.S. hospitals. Reuters Health, Jan. 2, 2018

Patients With Atrial Fibrillation More Deadly In Rural U.S. Hospitals. PharmaInsider. January 3, 2018.

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