People living in rural areas in the United States who had a heart attack were nearly three times more likely to die before reaching hospital care than people in large metropolitan areas, according to preliminary research to be presented at the American Heart Association's Scientific Sessions 2026. The analysis drew on 20 years of national U.S. hospital data from the CDC's WONDER database. Death before hospital arrival, or death while in outpatient or emergency care, was also more common among Black adults than white adults in rural settings, according to the research highlights. 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. The findings underline the importance of distance to emergency care, ambulance response times and access to cardiac services in rural communities. As with other meeting abstracts, the findings are considered preliminary until published as a full peer-reviewed manuscript.