Summary
A Nature Medicine analysis classified US communities with high cardiovascular disease burden and limited cardiology workforce by their readiness for digital care. Most of the analysed tracts were assigned investment priorities, where infrastructure or adoption support may be needed.
A study published in Nature Medicine classified US communities with high cardiovascular disease burden and constrained access to cardiologists according to their readiness for digital care. Across the analysed areas, 18% of qualifying census tracts were designated deployment priorities, while 82% were classified as investment priorities—places where support to address readiness barriers may be needed first.
The researchers linked national data on cardiometabolic disease burden, cardiology workforce and digital readiness across 82,999 US census tracts. Census tracts are small geographic units used to organise US population data. The analysis focused on high-burden tracts in counties with no cardiologist or a declining number of cardiologists per resident.
Readiness varied across high-burden communities
Among those tracts, 4,765—representing 19.9 million residents—had higher digital readiness and were labelled deployment-priority tracts. Another 21,752 tracts, with 74.1 million residents, had lower readiness and were labelled investment-priority tracts.
Digital readiness matters because digital cardiovascular care depends on more than the availability of a service. The study describes relevant conditions including infrastructure, access to devices, affordability and communities’ capacity to use digital services. A low-readiness classification therefore signals potential groundwork needs, rather than simply indicating that a digital service should be introduced immediately.
The investment-priority tracts appeared across the urban-to-rural range. The researchers also found differing barriers, including challenges with adoption and with infrastructure. The abstract does not assign each barrier to a specific type of community, but the distinction points to why a single implementation approach may not fit every area.
Why local targeting matters
Neighbouring census tracts within the same metropolitan area could receive different classifications. That geographic variation may be missed when planning is conducted only at county level, the researchers said. In practice, a regional label can conceal nearby communities with different readiness and support needs.
The findings were broadly consistent across nine additional analyses that varied the measures of digital readiness and workforce access, as well as the thresholds used to classify areas. The study offers a national framework for distinguishing places where digital cardiovascular care may be deployed from places where investment in readiness may be a prior step.
This is a geographic planning analysis: its outcome is a classification of community burden, workforce context and digital readiness, rather than results from a trial of digital care or patient health outcomes. The article was published on 5 November 2026 as an early version of peer-reviewed, accepted research, with further edits expected before the final version of record.