Millions of Americans face the risk of developing and dying from heart disease while living in “cardiology deserts”—areas without a single heart specialist.
A recent study published in the Journal of the American College of Cardiology reveals that nearly half of all U.S. counties lack a practicing cardiologist. Most of these counties are rural, with residents generally having more complex health issues.
“The counties that lack cardiologists probably need this specialty care even more,” said Dr. Haider Warraich, senior author of the study and a cardiologist at Brigham and Women’s Hospital in Boston. Residents in these counties “have a much higher prevalence of cardiovascular risk factors, including obesity, diabetes, smoking, high blood pressure, and high cholesterol.”
Warraich’s research, conducted with the web-based pharmacy GoodRx, shows that out of 3,143 U.S. counties, 46.3% do not have a cardiologist. Of these, 86.2% are rural counties with lower income levels, less access to healthy food, and fewer overall healthcare providers.
Although heart disease is the leading cause of death in the nation, rural residents are dying earlier and more frequently from preventable heart conditions, according to a May report by the Centers for Disease Control and Prevention (CDC).
“We’ve got small towns with high health needs and the inability to seek care,” said Alan Morgan, CEO of the National Rural Health Association.
Counties with cardiologists average 24 specialists each, but 10% have only one cardiologist for the entire county.
This situation spurred Warraich’s interest in studying cardiovascular disparities. Before moving to Boston in 2019, he was the sole cardiologist in Randolph County, North Carolina, serving a population of 146,043.
“I had no backup. I had no colleague I could call,” Warraich said. “I knew the people I was seeing had nowhere else to turn and were entirely dependent on me.”
Warraich’s data shows that Randolph County now has five cardiologists.
A ‘Workable Solution’
Living in a cardiology desert often means traveling farther for heart care. The study found that people in counties with a cardiologist drive an average of 16 miles round trip for an appointment, compared to 87 miles for those without a local cardiologist.
“That’s actually pretty good for a lot of our patients,” said Dr. John Wagener, medical director of the Avera Heart Hospital in Sioux Falls, South Dakota. “We have people who live three, four hours away to see us.”
Wagener and about 20 Avera Health cardiologists serve 86 counties in the Dakotas, Iowa, Minnesota, and Nebraska. Patients either travel for in-person appointments or increasingly use telemedicine.
Wagener said his team also provides consultation with numerous independent providers and those within the Avera Health network. “I’m constantly talking with primary care physicians, nurse practitioners, or physician assistants managing local emergency departments, critical care facilities, urgent cares, and primary care facilities,” Wagener said. “They can ask us questions and upload EKGs and telemetry reports so we can provide the best guidance.”
Dr. Steve Ommen, a cardiologist at the Mayo Clinic in Rochester, Minnesota, noted that it’s not just the distance that prevents people from getting care. “For people with bad hips or backs, sometimes it’s just getting out of the house,” said Ommen, who is also the medical director at Mayo’s Center for Digital Health. “In those cases, remote care can be the great equalizer.”
Morgan of the National Rural Health Association emphasized that virtual treatment is a “workable solution moving forward.” He highlighted the importance of expanding broadband in these communities and ensuring adequate telehealth platforms. “We are never going to get enough cardiologists practicing in small towns across the U.S.,” Morgan said.
