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In a survey on 6 major quality indicators of inpatient care provided to patients with acute myocardial infarction, Sheikh and Bullock¹ showed how lower performance was achieved in rural than in urban hospitals. The authors concluded that there were greater opportunities for improving delivery of care in rural areas compared with metropolitan regions. While interesting, I feel this assertion only applies to the contexts studied to date and does not automatically apply to any setting. For example, a prospective Italian study recently compared 2 defined populations admitted for coronary angiography between June l, 1992, and May 31, 1993: the residents of central Padua, classified as urban, and the residents of the Cittadella Health Authority, classified as rural.² The utilization rate was 8 per 10 000 of the population in the urban group and 10 per 10 000 of the population in the mini-group. In accordance with American College of Cardiology/American Heart Association . . . [Full Text of this Article]

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