{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T16:51:55Z","timestamp":1778777515447,"version":"3.51.4"},"reference-count":41,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,4,2]],"date-time":"2023-04-02T00:00:00Z","timestamp":1680393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To compare longitudinal rates of health care utilization, evidence\u2010based treatment, and mortality between rural and urban\u2010dwelling patients with congestive heart failure (CHF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used electronic medical record data from the Veterans Health Administration (VHA) to identify adult patients with CHF from 2012 through 2017. We stratified our cohort using left ventricular ejection fraction percentage at diagnosis (&lt;40% = reduced ejection fraction [HFrEF]; 40%\u201050% = midrange ejection fraction [HFmrEF]; &gt;50% = preserved ejection fraction [HFpEF]). Within each ejection fraction cohort, we stratified patients into rural or urban groups. We used Poisson regression to estimate annual rates of health care utilization and CHF treatment. We used Fine and Gray regression to estimate annual hazards of CHF and non\u2010CHF mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>One\u2010third of patients with HFrEF (N = 37,928\/109,110), HFmrEF (N = 24,447\/68,398), and HFpEF (N = 39,298\/109,283) resided in a rural area. Rural compared to urban patients used VHA facilities at similar or lower annual rates for outpatient specialty care across all ejection fraction cohorts. Rural patients used VHA facilities at similar or higher rates for primary care and telemedicine\u2010delivered specialty care. They also had lower and declining rates of VHA inpatient and urgent care use over time. There were no meaningful rural\u2010urban differences in treatment receipt among patients with HFrEF. On multivariable analysis, the rate of CHF and non\u2010CHF mortality was similar between rural and urban patients in each ejection fraction cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings suggest the VHA may have mitigated access and health outcome disparities typically observed for rural patients with CHF.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.12756","type":"journal-article","created":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T01:49:40Z","timestamp":1680486580000},"page":"844-852","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Rural\u2010urban trends in health care utilization, treatment, and mortality among US veterans with congestive heart failure: A retrospective cohort study"],"prefix":"10.1111","volume":"39","author":[{"given":"Maya","family":"Aboumrad","sequence":"first","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"},{"name":"White River Junction Veterans Affairs Medical Center  White River Junction Vermont USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Peritz","sequence":"additional","affiliation":[{"name":"Department of Cardiology Dartmouth\u2010Hitchcock Medical Center  Lebanon New Hampshire USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Friedman","sequence":"additional","affiliation":[{"name":"White River Junction Veterans Affairs Medical Center  White River Junction Vermont USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabrielle","family":"Zwain","sequence":"additional","affiliation":[{"name":"White River Junction Veterans Affairs Medical Center  White River Junction Vermont USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley V.","family":"Watts","sequence":"additional","affiliation":[{"name":"White River Junction Veterans Affairs Medical Center  White River Junction Vermont USA"},{"name":"Department of Psychiatry Geisel School of Medicine at Dartmouth  Hanover New Hampshire USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia","family":"Taub","sequence":"additional","affiliation":[{"name":"Department of Cardiology Dartmouth\u2010Hitchcock Medical Center  Lebanon New Hampshire USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,4,2]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000558"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2015.09.023"},{"issue":"2","key":"e_1_2_8_4_1","first-page":"1447","article-title":"Effect of post\u2010discharge follow\u2010up care on re\u2010admissions among US veterans with congestive heart failure: a rural\u2010urban comparison","volume":"10","author":"Muus K","year":"2010","journal-title":"Rural 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