Although heart disease is the leading cause of death in the countryPeople living in rural areas are dying earlier and more often from heart disease that could have been prevented, according to a study Report from the Centers for Disease Control and Prevention published in May.
“We have small towns with high health care needs and an inability to seek care,” said Alan Morgan, executive director of the National Rural Health Association.
Counties with cardiologists have an average of 24 specialists, the new report found.
But 10% have only one cardiologist for the entire municipality.
It was this experience that fueled Warraich’s interest in studying cardiovascular disparities. Before taking his job in Boston in 2019, he was the only cardiologist practicing in Randolph County, North Carolina, population 146,043.
“I had no backup. I didn’t have any colleagues I could call,” he said. “I remember knowing that the people I served had nowhere else to turn, that they were entirely dependent on me to do my best.”
Warraich’s data shows Randolph County now has five cardiologists.
A ‘viable solution’
Living in a cardiology desert often means having to travel further to get specialized cardiac care.
The new research found that people in counties with a cardiologist drive an average of 15 miles round-trip for an appointment, compared to a 90-mile round-trip commute on average for people without a local cardiologist.
“This is actually really good for a lot of our patients,” said Dr. John Wagener, a structural interventional cardiologist and medical director of Avera Heart Hospital in Sioux Falls, South Dakota. “We have people who live three, four hours away. to come see us.”
Wagener and a team of about 20 Avera Health cardiologists cover 86 counties in the Dakotas, Iowa, Minnesota and Nebraska.
Patients are heading for in-person appointments or, increasingly, seeing their cardiologists via telemedicine.
Wagener said his team also consults with a large number of independent and Avera Health network providers.
“I am constantly talking to primary care physicians, nurse practitioners or physician assistants who manage our local emergency departments, acute care access facilities, urgent cares and primary care facilities,” Wagener said. “Not only can they ask us questions, but they can also upload electrocardiograms and telemetry reports [which look at heart rhythms] so we can give them the best guidance possible.”
Dr. Steve Ommen, a cardiologist at the Mayo Clinic in Rochester, Minn., said it’s not necessarily the number of miles people have to travel for appointments that prevents them from getting the care they need.
“For people who have hip or back problems, sometimes it’s just a problem with getting out of the house,” said Ommen, also medical director of the Mayo Center for Digital Health. In these cases, “remote care can be the great equalizer.”
In fact, Morgan of the National Rural Health Association said treating patients virtually is a “viable solution for the future.”
“This highlights the critical importance of expanding broadband in these communities and ensuring we have sufficient telehealth platforms,” Morgan said. “We will never get enough cardiologists working in small towns in the USA”
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