No Practicing Cardiologist in Nearly Half of US Counties, Despite Higher CV, Mortality Risk

A new analysis helps to define the geographic disparities in access to cardiovascular care, finding that 46.3% (1,454) of all U.S. counties, comprising 22 million residents, do not have a practicing cardiologist, and these counties tend to be more rural and socioeconomically disadvantaged, with a greater burden of cardiovascular disease. Of the rural counties, 86.2% did not have a cardiologist. In the other 1,689 counties, on average there were 24 cardiologists, according to the research letter published in JACC.

Using data from a variety of sources, including HealthLink Dimensions for county-level estimates, Jeong Hwan Kim, MD, Haider J. Warraich, MD et al., sought to understand access to care considering the widening disparities in cardiovascular disease outcomes between urban and rural areas.

Results showed that the average round trip to see the nearest cardiologist was longer for patients living in a county without compared with a cardiologist (87.1 miles vs. 16.3 miles). Furthermore, life expectancy was one year shorter for persons living in a county without a cardiologist, and they had a 31% higher cardiovascular risk index (2.8 vs. 2.1), greater prevalence of all risk factors and higher age-adjusted cardiovascular mortality rates.

Researchers also found that counties without a cardiologist were more likely to have a lower household income, higher uninsured levels, worse access to healthy food as well as primary care physicians, and more preventable hospitalizations. Of the racial groups examined, Native Americans were most likely to live in a county without a cardiologist. Counties in the South had the highest cardiovascular risk index, and they write that "the mismatch between [cardiovascular disease] burden and access to specialty care was greatest in the South, highlighting substantial geographic inequity in the [U.S.]"

"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. "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.

JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC, calls the study findings, "both enlightening and alarming, shedding light on the severe geographic disparities in access to cardiovascular care across the [U.S.]." He adds, "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."

Creating a culture of equitable cardiovascular care is one of the pillars of the ACC's Strategic Plan, and learning opportunities such as webinars on improving cardiovascular care in indigenous communities and tools like the Health Equity Heat Map advance this main objective.

Keywords: Risk Factors, Health Equity, Heart Disease Risk Factors, Primary Health Care, Social Determinants of Health

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