Expanding Access to Life-Saving Cardiac Care

Chris Darland, CEO, Peerbridge Health

Susan is a 62-year-old American woman residing in Tennessee who has a family history of heart disease and starts to feel chest pains. Her local hospital closed last year, and she’s more than 100 miles from the nearest cardiologist. Worse, that specialist is unavailable due to other appointments through the next 4 months. Meanwhile, the chest pains persist. For millions of Americans, this scenario is a harsh reality. The health care community has a responsibility to do better for them.

Heart Failure in the US

More than 6 million Americans are living with heart failure (HF), the leading cause of hospitalization among adults 65 and older. And more than 45 million people in the US are estimated to have stage B or pre-HF, but don’t know it because they have no symptoms.

Left undetected and untreated, HF will progress, claiming lives and adding more than $200 billion to our nation’s annual health care costs. Unfortunately, the high costs, long timelines, and inconvenience involved in testing patients for heart disease create obstacles to early detection.

This is especially true for the 61 million people living in rural America, where an appointment with a cardiologist could take months and involve extensive travel. In a 2020 call to action, the American Heart Association (AHA) and American Stroke Association (ASA) cited research data showing that rural Americans are 40% more likely to develop heart disease and are at a 30% higher risk of stroke than urban Americans.

For 80% of Americans with HF, diagnosis of this life-changing disease will come only after an emergency hospital visit. Sadly, less than half of heart disease patients whose initial diagnoses came in the emergency room will survive more than 5 years.

As the AHA and ASA call to action notes, the life expectancy of rural Americans is 3 years shorter than that of urban residents. Rural Americans are greatly impacted by social determinants of health (SDOH), such as low income or unemployment, transportation issues, and lack of access to healthy foods.

It's clear that lack of access to health care services creates barriers to early detection that could improve outcomes and save lives. It has become even more challenging in recent years for rural Americans to access medical and behavioral health care.

More than 100 (4%) rural hospitals shut their doors from 2013 through 2020, according to data from the General Accounting Office. These closures have resulted in rural Americans having to travel, on average, about 20 miles more than in the past for common services such as inpatient care.

The scarcity of health care resources in rural America can be seen in this interactive county-by-county map of the US by the Rural Health Information Hub. In most southern, midwestern, north central, and northwestern states, most counties have a shortage of primary care providers.

Transforming Remote Diagnostics

Susan’s story is a frightening reality for too many people. It’s time that the next generation steps in and gives her and millions of others the care they deserve. Fortunately, emerging technologies are allowing Americans to use hospital-grade cardiac diagnostics and monitoring tools in their homes, and at a far lower cost than undergoing tests at a hospital or cardiologist’s office.

These tools combine artificial intelligence (AI) with an inexpensive, wearable device that can perform remote electrocardiograms (ECGs). So, instead of waiting up to 15 weeks after experiencing symptoms of HF to finally get a diagnosis, patients can get one from a remote ECG device in 30 minutes. Further, while traditional cost of diagnosing heart failure in an inpatient setting can be as high as $10 000, the cost of testing using a remote ECG device at less than 5% of that cost.

New remote ECG devices are simpler and easier to use than Holter monitors, which require patients to attach 12 leads to their torso. And while Holter monitor leads must be worn for 24 to 48 hours to get accurate results, these newer ECG devices can conduct tests in less than an hour. Making remote ECG devices more wearer-friendly and continuously connected via cellular helps make sure rural patients (and their providers) can easily monitor their hearts for early signs of failure.

Conclusion

Rural Americans face formidable equity barriers to health care, even as they struggle with higher rates of chronic conditions such as heart disease. AI coupled with advanced remote monitoring hardware today can provide rural residents and their care teams with a hospital-grade ECG diagnostic and monitoring device that can be used at home. Early detection of HF has the potential to save lives and reduce patient and family anxiety for millions.