People living in rural areas who experience a heart attack are nearly three times more likely to die before reaching hospital care compared to residents of large metropolitan areas, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2026 in Chicago. The study, which analyzed 20 years of national death certificate data, highlights significant disparities in emergency cardiac care based on geography, race, age, and sex.
The research, led by Darshan Shivanne Gowda, M.B.B.S., a medical student at Hassan Institute of Medical Sciences in Karnataka, India, examined data from the CDC WONDER database for over 2.5 million adults who died from heart attacks between 2003 and 2023. It found that rural residents were about 89% more likely to die at home and 58% more likely to die in outpatient or emergency care settings than their urban counterparts. Black adults in rural settings were 16% more likely to die before hospital arrival and 25% more likely to die at outpatient facilities compared to white adults, which researchers suggest may reflect racial inequities in pre-hospital care. Men were 20% to 40% more likely to die before hospital arrival than women, and adults over 65 were up to six times more likely to die in long-term care facilities.
Young adults, particularly those aged 20 to 44, also disproportionately died from heart attacks outside of the hospital, possibly due to delayed recognition of symptoms. “Heart attacks are often perceived as primarily affecting older adults, so the finding that younger adults had the highest relative odds of death by the time they reached the hospital underscores the importance of recognizing heart attack symptoms across all age groups,” Gowda said.
The study’s findings underscore the critical need for timely emergency care. “Getting emergency care as soon as possible can make a major difference in a life-threatening situation,” Gowda added. He emphasized that people should know the Warning Signs of a Heart Attack and call 9-1-1 immediately when symptoms occur.
The American Heart Association has identified the rural health crisis as one of the top three barriers to achieving equitable health care access. The organization has funded a multi-pronged approach to improve health in rural America, including delivering resources to strengthen rural and tribal communities, funding scientific research, and creating a Rural Health Care Outcomes Accelerator to expand rural hospital participation in its Get With The Guidelines® program. More information about the association’s rural health initiatives is available at Rural Health | American Heart Association.
Johanna Paola Contreras, M.D., FAHA, a member of the American Heart Association’s International Committee and founder of its National Hispanic Latino Cardiovascular Collaborative, noted that rural communities may face longer distances to hospitals, fewer emergency and specialty cardiovascular services, and challenges with transportation. “Where someone lives should not determine whether they survive a cardiovascular emergency,” she said. Contreras, who was not involved in the study, stressed that responsibility for improving outcomes belongs to families, healthcare professionals, and policymakers.
The study’s limitations include its retrospective observational design, which cannot prove causation, and the use of place of death as an indirect measure of emergency care access. The findings are considered preliminary until published in a peer-reviewed journal. The abstract is available in the 2026 Online Program Planner, and additional details can be found in the release link.
This research highlights a pressing public health issue: where a person lives can significantly impact their chances of surviving a heart attack. With heart attacks occurring every 40 seconds in the U.S. and about half of fatal heart attacks happening outside of the hospital, according to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, these findings call for strengthened emergency medical services, prevention, and early recognition, particularly in rural communities.
