Solutions / Government — US

Cardiovascular disease is a public-infrastructure problem. Hiring cardiologists will not close it.

The Institute's U.S. government work is field science for specialist deserts, readmission policy, and rural capacity, using payment rails that already exist.

In 2023, cardiovascular disease accounted for 915,973 U.S. deaths, on average one every 34 seconds (AHA 2026). Direct and indirect cost was $414.7 billion in 2021–2022. 46.3% of U.S. counties (22 million people) have no cardiologist; 86.2% of rural counties have none (Kim et al., JACC 2024). HRSA projects a 7,270 FTE cardiology shortage by 2038.

Medicare's Hospital Readmission Reduction Program still withholds up to 3% of Medicare payments for excess 30-day readmissions. CMS estimated 78.2% of hospitals take a FY 2026 cut. National 30-day heart-failure readmission is 19.7% (CMS Care Compare, July 2021 through June 2024). CMS's Rural Health Transformation Program puts $50 billion into all 50 states for FY 2026 through 2030, including telehealth, remote physiologic monitoring, workforce, and chronic-disease management. Acute Hospital Care at Home now runs through September 30, 2030.

Cardiothoracic Field Science asks a public question: can a non-specialist, in a county that will never staff a full cardiology panel, manage the chest to a specialist standard if the recording is continuous and the decision support is explicit? The Institute's operating observation is that 83% of heart-failure patients never see a cardiologist.

U.S. measurement and management in this domain sit on existing CMS remote physiologic monitoring and cardiac monitoring codes. No new entitlement category is required for the research posture.

Dated field outcomes: Prevail Heart Clinics, rural U.S., 394 consecutive patients, October 2014 through May 2016, care predominantly by a physician assistant. All-cause 30-day readmission 6.1% versus a 24.7% contemporaneous Medicare CHF benchmark; heart-failure hospitalizations down 71.4% in year one. Not 2026 multi-site federal results. A larger outcomes refresh is underway.

This is infrastructure research, not a hospital gadget with a flag on it.