Research Highlights:
Embargoed until 4 a.m. CT/5 a.m. ET, Monday, Nov. 2, 2026
DALLAS, Nov. 2, 2026 — 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?
“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:
Co-authors, disclosures and funding sources are listed in the abstract.
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