And though heart disease is the nation’s No. 1 killer, people living in rural areas are dying earlier and more often from heart disease that could’ve been prevented, according to a Centers for Disease Control and Prevention report published in May.

“We’ve got small towns with high health needs and the inability to seek care,” said Alan Morgan, chief executive officer of the National Rural Health Association.

Counties with cardiologists have an average of 24 of the specialists, the new report found.

But 10% have just one cardiologist for the entire county.

It was this experience that fueled Warraich’s interest in studying cardiovascular disparities. Before he took 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 had no colleague I could call,” he said. “I remember just knowing that the people who I was seeing had nowhere else to turn, that they were entirely dependent on me to be at my best.”

Warraich’s data shows that Randolph County now has five cardiologists.

A ‘workable solution’

Living in a cardiology desert usually means having to travel farther for specialty heart care.

The new research found that people in counties with a cardiologist drive an average of 16 miles round trip for an appointment, compared to an 87-mile round trip, on average, for people without a local cardiologist.

“That’s actually pretty good for a lot of our patients,” said Dr. John Wagener, a structural interventional cardiologist and medical director of the Avera Heart Hospital in Sioux Falls, South Dakota. “We have people who live three, four hours away to come to see us.”

Wagener and a team of about 20 Avera Health cardiologists cover 86 counties in the Dakotas, Iowa, Minnesota and Nebraska.

Patients either drive for in-person appointments or, increasingly, see their cardiologists through telemedicine.

Wagener said his team also offers consultation with a vast number of both independent providers and those within the Avera Health network.

“I’m constantly talking with primary care physicians, nurse practitioners or physicians assistants who are managing our local emergency departments, critical care access facilities, urgent cares and primary care facilities,” Wagener said. “They can not only ask us questions, but they can upload EKGs and telemetry reports [which look at heart rhythms] so we can give them the best guidance as we can.”

Dr. Steve Ommen, a cardiologist at the Mayo Clinic in Rochester, Minnesota, 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 bad hips or bad backs, sometimes it’s just a problem of getting out of the house,” Ommen, also the medical director at Mayo’s Center for Digital Health, said. In those cases, “remote care can be the great equalizer.”

Indeed, Morgan of the National Rural Health Association said that treating patients virtually is a “workable solution moving forward.”

“This highlights the critical importance of expanding broadband in these communities and ensuring that we have enough telehealth platforms,” Morgan said. “We are never going to be able to get a sufficient number of cardiologists practicing in small towns across the U.S.”