Correspondence to:

BackgroundʊAccess to medical care differs between urban and rural residents but the magnitude of these differences and whether they impact outcomes is unknown. We aimed to determine whether outcomes differ for patients with incident heart failure (HF) by urban-rural status. Methods and ResultsʊCohort study using administrative data from Alberta, Canada. Patients with incident HF were identified from April 1,1999 to December 31,2005 and followed for 1-year. Multivariable logistic regression was used to assess differences in 1-year outcomes following initial HF diagnosis in patients living in rural vs. urban settings. We identified 72,043 incident HF patients (mean age 72±14, 50 % male); 12,173 (17%) died and 29,074 (39%) were hospitalized within 1-year. Although crude all-cause 1-year mortality rates were higher in urban compared to rural residents (17.3 % vs. 15.6%, p<0.001), following adjustment for comorbidities, no significant differences were observed (aOR 0.95, 95 % CI 0.90-1.00). However, sex specific analyses indicated that urban men had a significantly lower risk of mortality than rural me