Nearly half of all U.S. counties do not have a practicing cardiologist on staff, according to a recent study published in the Journal of the American College of Cardiology (JACC).
Rural communities are hit hardest, and Americans in those areas die earlier and more often from heart disease that could have been prevented, according to a May report from the Centers for Disease Control and Prevention (CDC).
The study, led by Brigham and Women's Hospital in Boston, looked at more than 3,100 counties.
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Forty-six percent of counties had no access to cardiologists —meaning that 22 million residents would not have access to heart-related care.
If we look at just rural counties, more than 86% of them did not have a cardiologist.
Nearly half of all U.S. counties do not have a practicing cardiologist on staff, according to a recent study published in the Journal of the American College of Cardiology. (iStock)
“While cardiologists are not the sole determinants of cardiovascular outcomes, the lack of access to cardiologists in areas with higher prevalence of heart disease and mortality is incredibly concerning,” said senior author Haider J. Warraich, MD, director of the heart failure program at VA Boston Healthcare and an associate physician at Brigham and Women's Hospital, in a news release.
How does this affect patients?
In counties without a cardiologist, patients have to travel an average of 87.1 miles to get the care they need, the study found.
“When a patient is having a heart attack, time matters,” said Dr. Bradley Serwer, a cardiologist and medical director of VitalSolution, a Headquartered in Cincinnati Company that offers cardiovascular and anesthesiology services to hospitals nationwide.
In counties where there is no cardiologist, patients have to travel an average of 87.1 miles to receive the care they need, the study found. (iStock)
“If a patient is unlucky enough to suffer a heart attack in a rural area, with no cardiology services, they are sometimes transported by ambulance or helicopter, but this takes time while the heart is dying.”
In some cases, these patients receive high risk medications called thrombolytics to help stop the heart attack, according to Serwer, who was not involved in the new study.
“Thrombolytics are an inferior option for treating heart attacks compared to primary percutaneous coronary intervention (PCI), also known as stenting,” Serwer said.
“When a patient has a heart attack, time matters.”
“Thrombolytics are a last resort when transfers are not possible or will take too long, as they are still better than the alternatives.”
Patients in rural counties have a higher age-adjusted cardiovascular mortality rate: on average, they live one year less than their urban cohorts, according to Serwer.
Why is there a shortage of cardiologists?
According to Serwer, several factors may contribute to the shortage of cardiology specialists in rural areas.
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“When they finish their training, many of them want to join a large group practice or a hospital-based practice, as it is comfortable to work alongside other cardiologists who can offer mentoring and guidance, especially early in their careers.”
“These deficiencies cause a delay in care and can mean the difference between life and death,” said a cardiologist. (iStock)
Many cardiologists are unwilling to leave an urban setting to move to a remote location, he noted, particularly if they have children who need access to more Schooling options.
Cardiologists in rural areas are also more likely to be overworked, Serwer said, because the community may have only one or two cardiology specialists. Often, the community lacks subspecialists such as CT surgeons, electrophysiologists or interventional cardiologists.
“These factors ultimately lead to less time spent with family and an unfavorable work-life balance,” the cardiologist explained.
Another challenge is that rural facilities require a complex system to transfer patients to a higher level of care, he continued.
“Inpatient and intensive care beds are hard to find in tertiary medical centers,” Serwer said. “These shortcomings result in a delay in care and can mean the difference between life and death, taking an emotional toll on rural health care providers.”
“Understand the importance of modifying cardiac risk factors with a healthy lifestyle, exercise, diet and medication adherence,” advised a cardiologist. (iStock)
There is also Refund Considerationsas many rural hospitals do not have the financial capacity to adequately pay their doctors, according to Serwer.
There is also a great need for anesthesiologists in rural counties, he added.
“Almost every hospital procedure requires an anesthesiologist, whether it's cardiology, obstetrics, orthopedics or general surgery.”
What is it that should happen?
According to Serwer, solving the rural healthcare dilemma should start with raising awareness and understanding the problems and constraints.
One option is to establish “creative staffing models” to cover more areas of the country.
One option is to establish “creative staffing models” to cover more parts of the country, Serwer said.
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His company, VitalSolution, partners with rural facilities to provide long-term coverage for cardiologists, nurse anesthetists, nurses and cath lab technicians.
“Our doctors work seven days and then have seven days off,” he said.
“This unique model allows our physicians to work where they are needed and live where they want – a win-win for community physicians and hospitals.”
Technology-based clinical support, such as telemedicine, should also be used more widely, a cardiologist recommended. (iStock)
Technology-based clinical support —such as telemedicine—should also be used more widely, Serwer recommended.
“We also need more government financial support for rural community hospitals and incentives for physicians, nurses, technologists and administrators,” he said.
Another option is to promote rural health care while in medical school, by requiring rotations in those communities, the cardiologist said.
“These rural rotations can be very rewarding and can help young physicians gain a more complete understanding of the practice of medicine.”
“Establish a relationship with a primary care provider and learn more about your chronic medical conditions,” one doctor advised. (iStock)
The study's researchers also called for policy changes to expand Internet availability for telemedicine access and expand health insurance coverage.
Managing modifiable risk factors for heart disease could also help reduce risk in rural communities, they said.
“This study underscores the urgent need for policy reforms and innovative solutions, such as financial incentives for physicians and expanded use of telemedicine, to close this gap,” Harlan M. Krumholz, MD, editor-in-chief of JACC, said in the release.
“Ensuring equitable access to cardiovascular care is a crucial step toward improving overall health. public health results and reduce preventable cardiovascular mortality.”
Short-term solutions
For patients currently living in one of the cardiac care “deserts,” Serwer recommended familiarizing themselves with the medical care available.
“Establish a relationship with a primary care provider and learn more about your chronic medical conditions,” she advised.
“Understanding the importance of modifying cardiac risk factors with healthy lifestyleexercise, diet and medication adherence,” he also said.
Those with a heart condition should make a plan for where and how to seek cardiac care if needed, the doctor said.
“They can also write to their elected officials to ask them to do more to complement the existing health care infrastructure,” Serwer added.
