Incarceration and electrophysiology care: A review of clinical, ethical, and systems-level challenges

Incarcerated individuals bear a disproportionate burden of cardiovascular disease and face significant barriers to specialty care, including in cardiac electrophysiology (EP). The impact of incarceration on EP care remains underrecognized and incompletely characterized.

To characterize how incarceration disrupts the delivery of cardiac EP care, identify clinical and system-level barriers, and propose opportunities to improve access and quality.

We conducted a narrative review of the literature on incarceration, cardiovascular disease, and EP care.

High-quality EP care depends on care continuity, specialized diagnostics, procedural access, and longitudinal device and medication management-features that conflict with the structural, financial, and logistical constraints of incarceration. This review describes healthcare delivery in carceral systems, highlights the unique vulnerability of heart rhythm care in these environments, and identifies opportunities to improve access and quality.

EP care in incarcerated populations is understudied and likely falls below community standards. As the incarcerated population ages, demand for quality EP care will grow. Addressing this gap will require coordinated policy, health system, and research initiatives to ensure equitable access to EP care for incarcerated and formerly incarcerated individuals.