Rural residents faced nearly 3x higher risk of heart attack death before reaching a hospital

Research Highlights:

• Compared to city residents, people living in rural areas who had a heart attack had a nearly threefold higher risk of dying before they got to a hospital, according to an analysis of 20-years of national U.S. hospital data from the CDC’s WONDER database.
• Heart attack-related death prior to hospital arrival, or death while in outpatient or emergency care settings were also more common among Black adults than white adults in rural settings.
• Young adults, particularly those between ages 20 and 44, also disproportionately died from heart attacks outside of the hospital. This may be attributable to delayed recognition of heart attack among younger adults, researchers noted.
• Note: The study featured in this news release is a research abstract. Abstracts presented at American Heart Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

Embargoed until 4 a.m. CT/5 a.m. ET, Monday, Nov. 2, 2026

November 2, 2026 (NEWMEDIAWIRE) - DALLAS - People living in rural areas who experienced a heart attack were nearly three times more likely to die before reaching hospital care, compared to those living in large, metropolitan areas, according to new, independent, preliminary research to be presented at the American Heart Association’s Scientific Sessions 2026. The meeting, Nov. 6-9, in Chicago, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

In the U.S., someone experiences a heart attack every 40 seconds, according to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, with about 50% of fatal heart attacks occurring outside of the hospital.

Previously, there was limited data on exactly which populations and demographics were at greater risk of death before reaching hospital care. This study explored participants’ location at the time of heart attack and death, distance to the nearest hospital and whether deaths differed according to their age, sex, race, Hispanic ethnicity, and urban or rural residency.

“Getting emergency care as soon as possible can make a major difference in a life-threatening situation,” said study author Darshan Shivanne Gowda, M.B.B.S, a medical student at Hassan Institute of Medical Sciences in Karnataka, India. “We found that people who live in rural areas and certain other populations were more likely to die before receiving urgent care for a heart attack that would improve their chances of survival.”

What are the study’s main findings?

• Rural residents were nearly three times more likely to die before hospital arrival, as well as about 89% more likely to die at home and 58% more likely to die in outpatient or emergency care settings than people who live in large, metropolitan areas.
• Black adults who experienced heart attacks were about 16% more likely to die prior to arrival at the hospital and 25% more likely to die at outpatient facilities compared to white adults, which may reflect racial inequities in pre-hospital care.
• In contrast, Hispanic adults who died from heart attacks were more likely to die in the hospital than non-Hispanic adults.
• Overall, men were 20%-40% more likely to die from a heart attack before hospital arrival than women.
• Adults older than age 65 were up to six times more likely to die in a long-term care facility after a heart attack.
• Young adults, particularly those between ages 20 and 44, disproportionately died from heart attacks that occurred outside of the hospital, potentially because of delayed recognition of heart attacks among this age group.

“The message for patients and families is simple: know the warning signs of a heart attack and do not wait to seek help,” Gowda said. “Call 9-1-1 immediately when symptoms occur. At the same time, our findings show that communities need reliable emergency medical services and timely access to specialized heart attack care, regardless of where people live.”

“We were also struck by the higher likelihood of out-of-hospital death among younger adults,” he said. “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.”

The American Heart Association has identified the rural health crisis as one of the top three barriers to achieving health care access and improving care for all people, everywhere. Recognizing the gaps in healthcare for rural Americans, the Association has funded a multi-pronged approach to improving health in rural America. Projects include delivering resources (such as self-measured blood pressure monitors, CPR education, addressing nutrition insecurity and youth engagement program) to strengthen rural and tribal communities by training a public health workforce; funding a scientific research initiative comprised of a network of special projects focused on advancing the understanding of the factors that impact health in rural America; and creating a Rural Health Care Outcomes Accelerator to expand rural hospital participation in Get With The Guidelines®, the American Heart Association’s proven, evidence-based, in-hospital approach to improving patient outcomes by promoting consistent adherence to the latest research-driven guidelines and measurement.

“Heart attack is a time-sensitive emergency,” said Johanna Paola Contreras, M.D., FAHA, a member of the American Heart Association’s International Committee and Community Engagement Committee and founder of the association’s National Hispanic Latino Cardiovascular Collaborative. “Rural communities may face longer distances to hospitals, fewer emergency and specialty cardiovascular services, and challenges with transportation and access to timely care. Although this study cannot tell us which of these factors explains the difference, the findings reinforce the importance of strengthening emergency medical services, prevention, early recognition and access to specialized cardiovascular care in rural communities. Our goal should be simple: where someone lives should not determine whether they survive a cardiovascular emergency.”

Contreras, who was not involved in this research, is an associate professor of medicine (cardiology) at Icahn School of Medicine at Mount Sinai; director of Heart Failure and Cardiomyopathy Clinical and Research Network at Mount Sinai Fuster Heart Hospital and medical director of the Hispanic Heart Center at Mount Sinai Health System in New York City. She noted that the responsibility for improving outcomes among rural patients belongs to families, healthcare professionals and policy makers.

“Everyone must know the warning signs of a heart attack and act quickly,” she said. “If symptoms suggest a heart attack, call 9-1-1 rather than trying to drive yourself to the hospital. And importantly, being young does not exclude the possibility of a heart attack. The disproportionate number of out-of-hospital deaths among younger adults in this study reminds us that serious cardiovascular symptoms need to be recognized at every age. Communities and health systems must also provide reliable emergency medical services and pathways that allow people to reach appropriate cardiovascular care quickly, particularly when they live far from a hospital.”

Study details, background, design and limitations:

• Researchers reviewed death certificate data from the CDC WONDER database for deaths occurring in the U.S. between 2003 and 2023.
• The study analyzed the place of the heart attack and death for more than 2.5 million adults (ages 20 or older) who died from heart attack.
• Rural areas were defined as counties outside metropolitan areas and classified as either micropolitan or noncore areas. Micropolitan areas center around small urban clusters of 10,000-49,999 residents, whereas noncore areas lack a substantial urban center and represent more geographically isolated rural communities, Gowda explained.
• Place of death was categorized as upon hospital arrival, outpatient or emergency setting, home, hospice or nursing home/long-term care facilities.
• The retrospective, observational study cannot prove direct causation among social demographic factors, location and death.
• Place of death is an indirect measure of emergency care access because it does not directly account for when heart attack symptoms began, emergency response and transportation times, distance to hospitals, proximity to heart attack specialty care, or other delays in seeking or accessing care.

Co-authors, disclosures and funding sources are listed in the abstract.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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Additional Resources:

• Multimedia is available on the right column of the release link.
• Spanish news release
• Link to abstract and the American Heart Association’s Scientific Sessions 2026 Online Program Planner
• American Heart Association health information: Warning Signs of a Heart Attack
• American Heart Association health information: Rural Health | American Heart Association
• American Heart Association news release: Deaths from cardiovascular disease increased among younger U.S adults in rural areas (Nov. 2024)
• American Heart Association news release: Original YouTube TM docuseries focuses on health inequities and challenges in rural America (May 2024)
• About Scientific Sessions 2026
• For more news at the American Heart Association’s Scientific Sessions 2026, follow us on X @HeartNews, #ScientificSessions26

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

For Media Inquiries and American Heart Association Expert Perspective: 214-706-1173

American Heart Association Communications & Media Relations in Dallas: [email protected]

Bridgette McNeill: [email protected]

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