Long-term outcomes among stable post-acute myocardial infarction patients living in rural versus urban areas: insights from the prospective, observational TIGRIS registry
Satoshi Yasuda,
Christopher B Granger,
David B Brieger,
Shaun G Goodman,
Tabassome Simon,
Dirk Westermann,
Ruth Owen,
Mauricio G Cohen,
Katarina Hedman,
Stuart J Pocock,
Jose Carlos Nicolau,
Remo H M Furtado,
Phillip R Hunt
Affiliations
Satoshi Yasuda
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
Christopher B Granger
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
David B Brieger
Cardiology Department, Concord Hospital, Sydney, New South Wales, Australia
Shaun G Goodman
Terrence Donnelly Heart Centre, St Michael`s Hospital, University of Toronto, Toronto, Ontario, Canada
Tabassome Simon
Department of Clinical Pharmacology and Research Platform of East of Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
Dirk Westermann
Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany
Ruth Owen
London School of Hygiene and Tropical Medicine, London, UK
Mauricio G Cohen
Cleveland Clinic Florida, Heart & Vascular Center, Cleveland, Ohio, USA
Katarina Hedman
BioPharmaceuticals R&D, CVRM Biometrics, AstraZeneca, Gothenburg, Sweden
Stuart J Pocock
London School of Hygiene and Tropical Medicine, London, UK
Jose Carlos Nicolau
Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
Remo H M Furtado
Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
Phillip R Hunt
Medical Affairs, Cardiovascular, Renal and Metabolism, AstraZeneca, Gaithersburg, Maryland, USA
Background Insights on the differences in clinical outcomes, quality of life (QoL) and health resource utilisation (HRU) with different levels of care available to post-acute myocardial infarction (AMI) populations in rural and urban settings are limited.Methods The long-Term rIsk, clinical manaGement, and healthcare Resource utilisation of stable coronary artery dISease (TIGRIS), a prospective, observational registry, enrolled 8452 patients aged ≥50 years 1–3 years post-AMI from June 2013 to November 2014 from 24 countries in Asia Pacific/Australia, Europe, North America and South America. Differences in QoL (measured using the EuroQol Research Foundation instrument) and HRU between patients in rural and urban settings were evaluated in this post hoc analysis. The incidence of clinical endpoints (cardiovascular (CV) death, AMI, unstable angina with urgent revascularisation and stroke; bleeding; and all-cause mortality) was analysed. Data were collected at baseline and every 6 months for 24 months.Results There were fewer hospitalisations and visits to general practitioners (GPs) and cardiologists in the rural versus urban populations (adjusted event rate ratio (ERR)=0.90 (95% CI, 0.82 to 1.00, p=0.04); ERR=0.84 (95% CI, 0.78 to 0.92, p<0.001); ERR=0.86 (95% CI, 0.81 to 0.92, p<0.001), respectively). No statistically significant differences were observed between rural and urban populations in all-cause death, AMI, unstable angina with urgent revascularisation, CV death, stroke, major bleeding events and health-related QoL. The adjusted incidence rate ratio was 0.92 (95% CI, 0.74 to 1.15) for the composite of CV death, AMI and stroke.Conclusions Living in rural areas was associated with fewer GP/cardiologist visits and hospitalisations; no significant differences in clinical outcomes and QoL were observed.Trial registration number NCT01866904.
