Cardiovascular Access Gaps in High-Deprivation U.S. Counties With Premature CVD Mortality.

BACKGROUND: Premature cardiovascular disease (CVD) mortality in the United States is geographically uneven, but prevention planning requires identifying whether high-burden communities face limited cardiovascular care infrastructure. METHODS: Beginning with an England-U.S. comparison, we identified a high-risk U.S. county tail, defined as counties in both the highest deprivation quintile and the top quartile of county-level mean premature CVD mortality. We characterized these counties by rurality, cardiometabolic risk factors, insurance, primary care capacity, cardiology workforce, and cardiac-service availability. RESULTS: High-risk-tail counties were predominantly rural, had higher risk-factor burden and uninsurance, and had lower primary care and cardiovascular physician density. Most lacked local patient-care cardiovascular physicians, adult cardiology services, diagnostic catheterization, interventional catheterization, and cardiac rehabilitation. CONCLUSIONS: High-deprivation U.S. counties with excess premature CVD mortality represent a structural cardiovascular care gap. Geographically targeted prevention, workforce planning, and cardiac rehabilitation access should prioritize areas where premature mortality, deprivation, rurality, and limited cardiovascular infrastructure overlap.