| Affiliation: | 1. Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada;2. Institute for Clinical Evaluative Sciences, Ontario, Canada;3. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada;4. Sunnybrook Schulich Heart Centre, University of Toronto, Toronto, Ontario, Canada;5. Clinical Services, University of Ottawa Heart Institute, Ottawa, Ontario, Canada;6. Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada;7. Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada;8. Canadian Women''s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada;9. Division of Cardiology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada |
| Abstract: | ![]()
BackgroundDifferences 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 for patients with ambulatory heart failure (HF). We examined the temporal incidence and mortality trends by geography in these patients.Methods and ResultsWe conducted a retrospective cohort study of 36,175 eastern Ontario residents who were diagnosed with HF in an outpatient setting from 1994 to 2013. The primary outcome was 1-year mortality. We examined temporal changes in mortality risk factors with the use of 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 with rural women.ConclusionsThe 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 compared with rural women. Further research should focus on ways to reduce this gap in the outcomes of men and women with HF. |
