Digital readiness for cardiovascular care in high-burden US communities with cardiology workforce constraints

Digital health may extend cardiovascular care in communities with limited specialist access, but its effectiveness depends on whether communities have the infrastructure, devices, affordability, and capacity needed to use digital services. We linked national data on cardiometabolic burden, cardiology workforce, and digital readiness across 82,999 US census tracts to identify communities where digital cardiovascular care could be deployed and those where enabling investment may be needed first. Among 49,948 tracts in 2,582 counties with no cardiologist or declining per-capita cardiologist supply, 26,517 had above-average cardiometabolic burden. Of these, 4,765 had digital readiness at or above the national median and were classified as deployment-priority tracts, whereas 21,752 had lower readiness and were classified as investment-priority tracts. Investment-priority tracts clustered in the rural Southwest, Deep South, Mississippi Delta, and Gulf and Florida metropolitan areas, whereas deployment-priority tracts were dispersed across urban counties nationwide. Contrasting classifications frequently occurred among neighboring census tracts within the same metropolitan area, highlighting geographic variation not captured by county-level targeting. Findings were broadly consistent across eight additional analyses varying measures of readiness, workforce access, and classification thresholds. We also developed public interactive dashboards that allow users to examine local patterns and modify classification thresholds. These findings provide a national framework for distinguishing communities where digital cardiovascular care may be deployed from those where infrastructure and adoption support may be needed to enable equitable implementation.