Practice-based cardiovascular research in rural primary care: research priorities and implementation insights

Cardiovascular disease is the leading cause of death in the United States, and cardiovascular mortality is higher in rural areas than in urban areas. However, innovations in cardiovascular care are typically produced in urban areas where social structures and culture can differ from those of rural areas.

From 2023 to 2024, we surveyed rural-serving primary care health care workers and cardiologists (n = 31) and rural patients (N = 14) in Alaska, Idaho, and Washington about their priorities for cardiovascular health services and disease research in rural areas. We also conducted semi-structured interviews with 27 of the health care workers we surveyed to explore their prior experiences with barriers to and facilitators of intervention implementation. We summarized the quantitative survey results with descriptive statistics and write-in responses using content analysis. To analyze the qualitative interview results, we used thematic analysis.

The highest rated research priorities focused on developing data sharing systems for rural clinics and hospitals and strengthening regional connections to support cardiovascular care. Patients also prioritized increasing health insurance coverage in rural communities. Both patients and health care workers rated studying the use of telemedicine and digital tools as their lowest priority but wrote in various technology-related topics as top research priorities. When evaluating key influences on previous implementation experiences, the interview participants highlighted factors including the need for time, money, and dedicated staff to run interventions; organization and provider buy-in; opportunities to partner with other organizations; and the importance of considering patients' perspectives and needs.

Rural patients and rural-serving health care workers prioritize cardiovascular research areas that are patient-focused, focus on technology that is feasible in the rural context, and aim to increase resources in rural communities. Funding for rural health care and improving rural healthcare provider shortages remain key issues. However, partnering with other organizations may be a means to support intervention implementation in rural clinics.