Abstract Body: Background: In the United States, rural residents face unique challenges that affect their overall cardiovascular health and mortality including access to care for acute cardiovascular conditions. We assessed differences in mortality and mode of care among adult patients diagnosed with acute myocardial infarction (AMI) based on geographical residence.

Methods: Using data from the Medicare Provider Analysis and Review files, we identified adult patients aged 45 and older who were diagnosed with AMI between 2015 and 2019. Cox-proportional hazards regression models were constructed to determine the association between patient’s geographic residence (rural vs. urban) on 30- and 90-day all-cause mortality.

Results: A total of 868,955 adult patients diagnosed with AMI were included in this study. Twenty-six percent of the sample resided in rural areas. Among rural residents with AMI, 46% were managed invasively with either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery which was similar to 45% of urban residents. After controlling for age, race, sex, and comorbid conditions, rural residents had a higher risk of death compared to urban patients (aHR 1.04, p<0.001) at 30 and 90 days. In subgroup analyses, a similar pattern was observed among those who did not undergo invasive procedures (aHR 1.06, p<0.001), however, there was no differences in mortality at 30 days (aHR 0.99, p=0.30) and 90 days (aHR: 0.99, p=0.36) between rural and urban residents who were managed by PCI or CABG.

Conclusion: Rural patients with AMI had a higher mortality risk than their urban counterparts, and this difference was driven by a higher death rate among those managed conservatively. Further investigation is needed to understand the underlying factors driving rural-urban disparities in mortality, particularly with non-invasive management of AMI.