New research identifies 4,765 U.S. census tracts where digital cardiovascular care could be deployed to serve 19.9 million residents, while 21,752 tracts representing 74.1 million people require infrastructure investment first. Posted September 13, 2026, the study provides a national framework for equitable digital health implementation in communities with cardiology workforce constraints.
Cardiovascular disease remains the leading cause of death in the United States, yet access to specialist care is profoundly uneven. Nearly half of U.S. counties have no practicing cardiologist, and residents in these areas face a greater burden of cardiovascular risk factors and mortality. Digital health technologies—including telecardiology, remote monitoring, and wearable devices—offer a potential solution to extend specialist capacity beyond traditional care sites. However, their effectiveness depends entirely on whether communities possess the necessary infrastructure, devices, affordability, and capacity to utilize these services.
For this study, researchers linked national data on cardiometabolic disease burden, cardiology workforce, and digital readiness across 82,999 U.S. census tracts. They focused on high-burden areas in counties with no cardiologist or a declining per-capita supply of cardiologists. Among 26,517 such high-burden tracts, 4,765 had digital readiness at or above the national median and were classified as “deployment-priority,” while 21,752 were designated “investment-priority.” The findings were broadly consistent across nine additional analyses with varying measures of readiness, workforce access, and classification thresholds, demonstrating the robustness of this classification system.
Mapping the Digital Divide in Cardiovascular Care
The stark geographic variation revealed by this research challenges conventional county-level targeting strategies. Investment-priority tracts were not confined to rural areas; they clustered in specific regions like the rural Southwest, Deep South, Mississippi Delta, and within certain metropolitan areas in the Gulf Coast and Florida. Conversely, deployment-priority tracts were dispersed across urban counties nationwide. Critically, the study found that contrasting classifications frequently occurred among neighboring census tracts within the same metropolitan area, highlighting that readiness can vary dramatically over very short distances.
This granular approach is essential because a community’s ability to benefit from digital health is not a simple binary of urban versus rural. The medrxiv.org report noted that investment-priority tracts faced different barriers, some related to technology adoption and others to fundamental infrastructure. A tract might have the necessary broadband access but lack the devices or capacity among its population, or vice versa. This nuance is critical for directing resources effectively.
Tailoring Digital Health to Local Needs
- Digital care isn’t one-size-fits-all: Some communities are ready for telehealth and remote monitoring now, while others need foundational support like better internet access or device availability first.
- Your neighborhood matters more than your county: Readiness for digital health can change block by block, meaning solutions must be tailored to very specific local needs, not just broad regional plans.
- Equity requires investment: For digital cardiovascular care to reduce health disparities, resources must be directed first to the 74 million Americans in “investment-priority” tracts to build the necessary capacity before services can be deployed.
The premise for deploying digital cardiovascular care is supported by clinical evidence. Randomized trials have shown that selected remote-care strategies improve outcomes in heart failure and hypertension. This establishes the mechanism of action: by increasing specialist access and enabling continuous patient monitoring, digital tools can bridge gaps in traditional care delivery.
However, the study underscores that this clinical efficacy cannot be realized in communities without the foundational digital infrastructure. The digital readiness concept used by the researchers, as described in the report, depends on whether communities have the infrastructure, devices, affordability, and capacity needed to use digital services. Without these, even the most effective telehealth platform will fail to engage patients or improve health outcomes.
Policies Must Address Local Healthcare Barriers
The findings have significant implications for regional healthcare systems in the United States. Because investment-priority tracts were spread across the urban-rural continuum and faced different barriers—adoption in some places, infrastructure in others—a single uniform policy response is unlikely to succeed. The researchers note that contrasting classifications frequently occurred among neighboring census tracts within the same metropolitan area, meaning that county-level targeting can miss important local variation.
The medrxiv.org report also mentions the development of public interactive dashboards that allow users to examine local patterns and modify classification thresholds, a crucial step for transparency and enabling local health departments to identify their own tract’s classification.
| Classification | Number of Census Tracts | Population Served | Primary Focus |
|---|---|---|---|
| Deployment-Priority | 4,765 | 19.9 million | Implementing digital cardiovascular care services |
| Investment-Priority | 21,752 | 74.1 million | Building digital infrastructure and adoption capacity |
Funding and Research Transparency
The study is currently available as a preprint on medRxiv, which means it has not yet undergone formal peer review. The authors themselves state that the preprint “should not be used to guide clinical practice,” a standard caution for preliminary findings. The work builds on a growing body of evidence about the digital divide in healthcare, highlighting the need for strong, data-driven strategies to ensure that technological advancements benefit all segments of the population equitably.
“These findings provide a national framework for distinguishing communities where digital cardiovascular care may be deployed from those where infrastructure and adoption support may first be needed to enable equitable implementation,” the authors concluded in the medrxiv.org report.
Consult Your Doctor for Cardiovascular Concerns
This research addresses systemic public health strategy, not a specific medical treatment or product. Therefore, there are no clinical contraindications for patients. However, the study’s findings have implications for patient access. If you live in an area identified as “investment-priority,” it means your community may lack the digital infrastructure needed to benefit from emerging telehealth services. This is not a reason for alarm, but it is a call to action for local healthcare advocacy. If you have cardiovascular concerns, you should continue to consult your primary care physician or seek in-person care. Do not delay necessary treatment while waiting for digital solutions to become available in your community. If you experience symptoms of a heart attack or stroke, such as chest pain, shortness of breath, or sudden weakness, call emergency services immediately.
The Path Forward for Equitable Cardiovascular Care
The study’s conclusion is a clear call for a two-pronged approach. For the 19.9 million residents in deployment-priority tracts, the focus should be on rapidly scaling evidence-based digital cardiovascular care models. For the 74.1 million in investment-priority tracts, the priority must be on building the foundational digital public health infrastructure.
The next step will be to translate this national framework into actionable local plans. The public dashboards developed by the researchers are a vital tool in this process, allowing policymakers and health systems to pinpoint exact areas of need. The success of this strategy will depend on its ability to adapt to the unique challenges of each tract, whether that means installing high-speed internet in a remote rural area or launching a smartphone training program for an elderly urban population.
References
- Perera S, Dhingra L, Batinica B, et al. Digital readiness for cardiovascular care in high-burden US communities with cardiology workforce constraints. medRxiv preprint posted September 13, 2026.
