{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T16:53:12Z","timestamp":1755795192213,"version":"3.44.0"},"reference-count":24,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T00:00:00Z","timestamp":1692403200000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2023,7,11]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The long-Term rIsk, clinical manaGement, and healthcare Resource utilisation of stable coronary artery dISease (TIGRIS), a prospective, observational registry, enrolled 8452 patients aged \u226550 years 1\u20133 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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&lt;0.001); ERR=0.86 (95% CI, 0.81 to 0.92, p&lt;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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Living in rural areas was associated with fewer GP\/cardiologist visits and hospitalisations; no significant differences in clinical outcomes and QoL were observed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT01866904\">NCT01866904<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2023-002326","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T12:36:26Z","timestamp":1692621386000},"page":"e002326","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Long-term outcomes among stable post-acute myocardial infarction patients living in rural versus urban areas: insights from the prospective, observational TIGRIS registry"],"prefix":"10.1136","volume":"10","clinical-trial-number":[{"clinical-trial-number":"nct01866904","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct01866904","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9680-3689","authenticated-orcid":false,"given":"Jose Carlos","family":"Nicolau","sequence":"first","affiliation":[{"name":"Instituto do Coracao (InCor), Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Owen","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Remo H M","family":"Furtado","sequence":"additional","affiliation":[{"name":"Instituto do Coracao (InCor), Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaun G","family":"Goodman","sequence":"additional","affiliation":[{"name":"Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher B","family":"Granger","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2038-6070","authenticated-orcid":false,"given":"Mauricio G","family":"Cohen","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Florida, Heart & Vascular Center, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7542-1956","authenticated-orcid":false,"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[{"name":"Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Yasuda","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tabassome","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology and Research Platform of East of Paris, Assistance Publique-H\u00f4pitaux de Paris, Paris, France"},{"name":"Sorbonne Universit\u00e9, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarina","family":"Hedman","sequence":"additional","affiliation":[{"name":"BioPharmaceuticals R&D, CVRM Biometrics, AstraZeneca, Gothenburg, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phillip R","family":"Hunt","sequence":"additional","affiliation":[{"name":"AstraZeneca, Gaithersburg, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6115-0326","authenticated-orcid":false,"given":"David B","family":"Brieger","sequence":"additional","affiliation":[{"name":"Cardiology Department, Concord Hospital, Sydney, New 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