Table 1
Characteristics of the cardiovascular hospitalisation population*.
| URBAN n = 880972% (95% CI) | REGIONAL n = 304961%; 95% CI | RURAL n = 105325%, 95% CI | |
|---|---|---|---|
| Male | 53.94 (53.83–54.04) | 54.01 (53.84–54.19) | 56.11 (55.81–56.40) |
| Female | 46.06 (45.96–46.17) | 45.98 (45.81–46.16) | 43.89 (43.60–44.19) |
| Age, y | |||
| 18–44 | 12.55 (12.48–12.62) | 9.22 (9.11–9.32) | 9.46 (9.28–9.64) |
| 45–64 | 28.69 (28.59–28.78) | 27.22 (27.06–27.38) | 29.32 (29.04–29.59) |
| 65–74 | 20.15 (20.07–20.23) | 23.06 (22.91–23.21) | 24.06 (23.80–24.31) |
| 75–84 | 22.92 (22.83–23.00) | 25.36 (25.20–25.51) | 24.41 (24.15–24.67) |
| 85+ | 15.70 (15.62–15.78) | 15.15 (15.02–15.27) | 12.76 (12.56–12.96) |
| Comorbidities | |||
| Cancer | 0.01 (0.01–0.02) | 0.01 (0.00–0.01) | 0.01 (0.01–0.02) |
| Congestive heart failure | 0.29 (0.28–0.30) | 0.17 (0.16–0.19) | 0.19 (0.16–0.21) |
| Diabetes | 0.51 (0.49–0.52) | 0.30 (0.28–0.32) | 0.36 (0.32–0.40) |
| Hypertension | 0.55 (0.53–0.56) | 0.34 (0.32–0.37) | 0.38 (0.35–0.42) |
| Obesity | 0.02 (0.01–0.02) | 0.02 (0.02–0.03) | 0.02 (0.01–0.03) |
| Renal failure | 0.19 (0.18–0.20) | 0.10 (0.09–0.11) | 0.11 (0.09–0.13) |
| Other comorbidity | 0.55 (0.53–0.56) | 0.29 (0.27–0.31) | 0.28 (0.25–0.31) |
| Diagnostic group | |||
| Arrythmia diagnosis | 12.70 (12.63–12.77) | 14.94 (14.82–15.07) | 14.90 (14.69–15.12) |
| Complete heart block | 0.51 (0.50–0.53) | 0.60 (0.58–0.63) | 0.64 (0.59–0.69) |
| Other heart block | 0.55 (0.54–0.57) | 0.68 (0.65–0.71) | 0.70 (0.65–0.75) |
| Sick sinus syndrome | 0.50 (0.49–0.52) | 0.53 (0.51–0.56) | 0.55 (0.51–0.60) |
| Atrial fibrillation/flutter | 8.78 (8.72–8.83) | 10.76 (10.65–10.87) | 10.50 (10.32–10.69) |
| Ventricular tachycardia/ventricular fibrillation/cardiac arrest | 1.22 (1.20–1.24) | 1.14 (1.10–1.18) | 1.16 (1.10–1.22) |
| Other arrythmia | 1.23 (1.21–1.25) | 1.48 (1.44–1.52) | 1.69 (1.62–1.77) |
| Cardiomyopathy diagnosis | 1.80 (1.77–1.83) | 2.47 (2.42–2.53) | 2.51 (2.42–2.60) |
| Ischaemic | 0.38 (0.36–0.39) | 0.49 (0.46–0.51) | 0.47 (0.43–0.51) |
| Non-ischaemic | 1.70 (1.67–1.73) | 2.35 (2.30–2.41) | 2.33 (2.24–2.43) |
| Syncope Diagnosis | 7.19 (7.13–7.24) | 6.22 (6.13–6.30) | 5.76 (5.62–5.90) |
[i] *All patients aged over 18 years who presented with selected cardiovascular conditions to a hospital in New South Wales from 2008 to 2018 (see Table S1 for International Classification of Diseases, Tenth Revision, Australian Modification codes). Percentages provided are of total patients from urban, regional and rural areas, respectively.
Table 2
Cardiac device implants in the cardiovascular hospitalisation population*.
| URBAN n (%, 95% CI) | REGIONAL n (%, 95% CI) | RURAL n (%, 95% CI) | |
|---|---|---|---|
| Cardiac device implant | 24303 (2.76, 2.71–2.82) | 5975 (1.96, 1.88–2.04) | 2338 (2.23, 2.08–2.38) |
| Pacemakers | 16897 (1.92, 1.89–1.95) | 4124 (1.35, 1.31–1.39) | 1522 (1.45, 1.37–1.52) |
| Implantable cardiac defibrillators | 5044 (0.57, 0.56–0.59) | 1244 (0.41, 0.39–0.43) | 578 (0.55, 0.51–0.60) |
| Cardiac resynchronisation therapy | 2362 (0.27, 0.26–0.28) | 607 (0.20, 0.18–0.22) | 238 (0.23, 0.20–0.26) |
[i] *All patients aged over 18 years who presented with selected cardiovascular conditions to a hospital in New South Wales from 2008 to 2018 (see Table S1 for International Classification of Diseases, Tenth Revision, Australian Modification codes). Percentages provided are of total patients from urban, regional and rural areas, respectively.
Figure 1
Adjusted odds ratio with 95% CI for CIEDs in regional and rural compared to urban (reference) locations. Adjusted for age and comorbidities. Odds ratio <1 suggests lower implantation rates in regional and rural compared to urban locations.
Figure 2
Trends in CIED insertion by remoteness.
Table 3
Adjusted* mortality rates (95% CI) at 30 days and five years after cardiac implantation for patients at urban versus regional and rural locations.
| REMOTENESS CATEGORY | PACEMAKER %, (95% CI), P VALUE** | DEFIBRILLATOR %, (95% CI), P VALUE** | CARDIAC RESYNCHRONISATION %, (95% CI), P VALUE** |
|---|---|---|---|
| 30-day mortality | |||
| Urban | 0.6 (0.5–0.7) | 0.9 (0.6–1.2) | 0.8 (0.5–1.1) |
| Regional | 0.7 (0.6–0.8), P = 0.5 | 1.0 (0.7–1.3), P = 0.8 | 0.8 (0.5–1.1), P = 0.8 |
| Rural | 0.7 (0.6–0.8), P = 0.15 | 1.1 (0.7–1.4), P = 0.5 | 0.9 (0.6–1.2), P = 0.5 |
| 5-year mortality | |||
| Urban | 23.7 (23.2–24.2) | 29.5 (28.2–30.7) | 24.2 (22.9–25.5) |
| Regional | 25.0 (24.5–25.6), P = 0.001 | 30.9 (29.6–32.2), P = 0.12 | 25.5 (24.2–26.8), P = 0.17 |
| Rural | 26.4 (25.8–27.0), P < 0.001 | 32.5 (31.1–33.8), P = 0.002 | 26.9 (25.5–28.3), P = 0.005 |
[i] *Rates are adjusted for age and presence of Elixhauser comorbidities.
**P value for mortality in remoteness category vs urban location.
Figure 3
Urban-rural disparity in cardiac implantable electronic device use: 10-year state-wide cohort of 32,616 consecutive CIED patients.