Study: Women Under 65, Patients With Heart Failure Have Higher Mortality Due to Coronary Artery Disease

Two separate studies published in the Journal of the American Heart Association have found significant health disparities regarding death due to coronary artery disease (CAD) among women and rural patients.

According to the researchers, women living in rural areas have a higher rate of premature death compared with those who are in more urban areas, and living in rural areas is a significant factor affecting heart failure survival.

Despite declines in heart disease-related deaths in recent decades, researchers have noted an increase among rural women aged 65 years or younger since 2009. The researchers analyzed and compared trends between 1999 and 2017 in premature deaths due to CAD among women living in rural and urban areas.

They found that deaths to CAD remained consistently higher in rural areas, regardless of sex, race, or age group. Although deaths have not increased overall among men, they noted that the rate of coronary artery disease deaths in patients aged 55-64 years stopped improving in small and medium towns in 2011, and in rural areas in 2008.

Among women in these rural areas, CAD death rates increased between 2011 and 2017 among those 55-64 years of age, as well as in women 45-54 years of age between 1999 and 2017. The estimated annual percentage change was 1.4% and 0.6%, respectively.

“This significant increase in coronary artery disease deaths among young women in the rural US is shocking,” said senior study author Federico Moccetti, MD, in a press release. “Disparities in the prevention and control of cardiovascular disease risk factors in these communities are likely the reason for this upswing.”

Notably, although some aspects of rural life, such as lack of access to an emergency department, may make a heart attack more deadly, the increase in distance didn’t affect men, according to the study. Thus, the researchers said some aspects of rural life may not account for the difference in death rates in rural women.

“This leads to the inevitable conclusion that an intensification of the public health efforts aimed at increasing cardiovascular health of rural women, during young adulthood, adolescence, and childhood are necessary,” Moccetti said.

A separate study evaluated social determinants of health and 90-day mortality following hospitalization for heart failure, and found that social determinants such as race, income, and living in a rural area have significant effects.

Of 690 patients (44% women), the investigators found that 79 people died within 90 days of their hospital discharge. Patients with only 1 social determinant of health factor were almost 3 times as likely to die as those who had no social factors. Patients with 2 or more social determinants were also approximately 3 times more likely to die as those who had none.

According to a statement, the researchers were surprised that multiple social determinants did not proportionately increase mortality risk. However, they said the findings could still significantly affect patient care. For example, patients with 1 or more social determinants of health could be more closely monitored following discharge through community-based or home care services.

“I think the powerful influence of these social determinants of health is incredible and underappreciated,” said Madeline R. Sterling, MD, MPH, MS, lead author of the study, in a press release. “Our findings add to a growing body of research that suggests social determinants matter.”

REFERENCE

Health disparities in rural US: Higher coronary artery disease death in women under 65 and people with heart failure [news release]. American Heart Association; April 22, 2020. https://newsroom.heart.org/news/health-disparities-in-rural-us-higher-coronary-artery-disease-death-in-women-under-65-and-people-with-heart-failure. Accessed April 23, 2020.