A new analysis reveals that 46.3% of US counties, mostly rural and socioeconomically disadvantaged, lack cardiologists.


Summary: A new analysis reveals that 46.3% of US counties lack a practicing cardiologist, with these areas being predominantly rural and socioeconomically disadvantaged. The absence of cardiologists in these counties is associated with higher cardiovascular risk factors, greater disease prevalence, and increased mortality rates. The study emphasizes the need for policy reforms and solutions, such as telemedicine and financial incentives, to improve cardiovascular care access and outcomes in underserved areas.

Key Takeaways:

  • Nearly half of US counties, primarily rural and disadvantaged, do not have a practicing cardiologist, contributing to significant healthcare disparities, new research finds.
  • Counties without cardiologists experience higher cardiovascular risk, increased mortality rates, and a one-year shorter life expectancy on average.
  • The study highlights the need for policy reforms, including telemedicine and financial incentives, to enhance access to cardiovascular care in underserved regions.

Nearly half of US counties do not have a practicing cardiologist, according to a new analysis published in JACC, the journal of the American College of Cardiology.

The analysis found that these counties tended to be more rural and socioeconomically disadvantaged, with a greater burden of cardiovascular disease. 

“While cardiologists are not the only determinants of cardiovascular outcomes, the lack of access to cardiologists in areas with greater prevalence of heart disease and mortality is incredibly concerning,” says Haider J. Warraich, MD, director of the heart failure program at VA Boston Healthcare, associate physician at Brigham and Women’s Hospital in Boston, and the study’s senior author, in a release.

Disparities in Cardiovascular Care

Upon analyzing all 3,143 US counties, it was determined that 1,454 counties (46.3%) with 22 million residents had no cardiologists while the other 1,689 counties each had 24 cardiologists on average.

Other findings included:

  • 86.2% of rural counties had no cardiologists.
  • The average round-trip distance to the nearest cardiologist was 16.3 miles versus 87.1 miles in counties with and without cardiologists.
  • Compared to counties with cardiologists, counties without cardiologists had:
    • 31% higher cardiovascular risk index
    • Greater prevalence of all risk factors
    • Higher age-adjusted cardiovascular mortality rates
    • One-year shorter life expectancy on average

Socioeconomic Factors and Health Outcomes

Counties without cardiologists were more likely to be rural with lower household incomes, greater uninsured levels, worse access to healthy food and primary care clinicians, and experienced more preventable hospitalizations. 

Of all the racial-ethnic groups examined, Native Americans were the most likely to be living in a county without a cardiologist. Counties lacking a cardiologist were unlikely to be on either coast of the US, and those in the South had the highest cardiovascular risk index.

Policy Recommendations

“Our findings really highlight the critical need to find ways to mitigate deep disparities to improve cardiovascular disease outcomes for Americans living in rural and disadvantaged areas,” Warraich says in a release. “Policy reforms, such as financial incentives to clinicians to practice in areas with marginal access or better leveraging telemedicine, are potential options. The integration and coordination of cardiovascular care—especially with regard to prevention and risk modification—with the primary care is crucial.”

According to the researchers, broader policy interventions to widen broadband access and increase digital literacy, increase access to adequate health insurance coverage and reducing prevalence of modifiable risk factors would also have a sustainable impact.

“The findings of this study are both enlightening and alarming, shedding light on the severe geographic disparities in access to cardiovascular care across the United States,” says JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC, in a release. “This study underscores the urgent need for policy reforms and innovative solutions, such as financial incentives for clinicians and the expanded use of telemedicine, to bridge this gap. Ensuring equitable access to cardiovascular care is a crucial step towards improving overall public health outcomes and reducing preventable cardiovascular mortality.”

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