In the United States, 46.3% of counties (1,454 of 3,143 counties) with a population of 22 million have no practicing cardiologist[1][2][3][4]. These districts are predominantly rural and socioeconomically disadvantaged, with 86.2% of rural districts without a cardiologist[1][2][4]. Counties with cardiologists average 24, while the average tampon distance to the nearest cardiologist is 87.1 miles versus 16.3 miles in counties with cardiologists[1][2][4]. Districts without a cardiologist have a 31% higher cardiovascular risk index (2.8 vs. 2.1), a higher prevalence of all risk factors, a higher age-adjusted cardiovascular mortality rate, and a one-year shorter life expectancy (76.4 vs. 77.3 years)[1][3][4]. These areas have lower household income, a higher share of the uninsured, poorer access to a healthy diet and primary care, as well as more predictable hospitalizations[1][2][3][4]. Native Americans and counties in the South with the highest cardiovascular risk index[1][2][4] are most affected.