This project will examine whether the availability of hospital-based cardiac testing services has changed over the past ten years in rural and urban counties and identify the characteristics of counties where service availability has changed.

We will conduct a longitudinal analysis using data from the American Hospital Association (AHA) annual survey from 2010 to 2020. The AHA data will be supplemented with data from the American Community Survey for corresponding years and CDC PLACES heart related disease estimates for 2020.

Analytic Method:

• Cardiac service availability at the county level will be determined by geocoding all hospitals in the AHA dataset from 2010 to 2020.
• Hospitals will be flagged if they provide onsite diagnostic catheterization, interventional catheterization, and cardiac rehabilitation.
• Each cardiac procedure will be mutually exclusive from one another.
• We will identify the proportion of counties with at least one hospital providing each of the three mentioned cardiac services each year from 2010 to 2020.
• Urban Influence Codes will be used to stratify the analysis by rurality.
• Linear trend tests will be used to determine whether there are significant differences in the rate of change over time at differing levels of rurality.
• Sociodemographic characteristics and heart-related disease prevalence of counties that lost or gained cardiac services from 2010 to 2020 will be examined.