According to the latest data from the American Heart Association, heart disease remains the leading cause of death in the United States, a position it has held for more than a century.
Advanced imaging tools can now identify early structural or functional heart issues, but they are largely reserved for acute or specialist care. Far too few U.S. adults receive preventive cardiovascular screenings. This disconnect exposes a fundamental flaw in how we approach heart health: we wait for illness instead of designing systems to detect risk early.
As a former physician, I’ve seen the consequences of late detection firsthand. And now as a healthcare leader, I see an even bigger issue. Our delivery models are misaligned with how prevention actually works.
The prevention paradox
We know that early screening can lead to prevention or early treatment, which ultimately saves lives. There are also significant cost savings to prevention over treatment. Yet what we’re seeing cardiac health care is episodic and highly inaccessible.
Primary care clinicians are often the first, and sometimes only, entryway to higher health needs for patients. But most cardiovascular screening during routine annuals is limited to basic vitals obtained by a quick pulse check. Advanced imaging tools which can pinpoint several risk factors are typically reserved for specialty settings and are only recommended after abnormal readings or symptoms are flagged.
This creates a structural blockage. Patients who may not fit the typical risk profile, or who live in areas with limited specialist access, may never receive deeper cardiac evaluation until disease has progressed. In fact, our research found that even those high-risk demographics are evading preventive options.
The result is millions of cardiac needs going unchecked and untreated. Not because clinicians lack awareness of the problem, but our system is not set up to make early detection routine or scalable. Prevention for the single largest killer of Americans is simply not operationalized.
Detection must become routine
If we are serious about reducing cardiovascular mortality, preventive detection must become as routine as treating symptoms — not a privilege reserved for those who already show signs of disease. That means deploying diagnostic tools that any clinician can use confidently, in the settings patients already frequent: primary care offices, community clinics, even retail health locations. The goal is to remove the barriers of specialist access and episodic care, and make early screening a standard part of how we see patients. We have the technology. We haven’t yet built the infrastructure to put it where it matters most.
Prevention is a systems problem, not a technology problem
The tools exist. What’s missing is alignment. Preventive cardiac care depends on better collaboration across the continuum – between diagnostics, primary care, and the follow-up pathways that turn early findings into early action. It also requires a fundamental shift in how we think about eligibility: moving from “who already qualifies based on symptoms” to “who could benefit before symptoms appear.” Until prevention is operationalized, heart disease will continue to outpace our best intentions.
The cost of waiting
Cardiovascular disease costs the U.S. healthcare system hundreds of billions of dollars annually. More importantly, it costs people years of healthy life that could have been preserved with earlier insight.
Prevention doesn’t require every patient to become a cardiology case. It requires giving clinicians better visibility into risk, earlier — and giving patients a chance to act before symptoms dictate their future.
Heart disease rarely begins suddenly. Our response shouldn’t either.
If we want different outcomes, we need to stop designing care around crisis and start building systems that recognize risk while there’s still time to change it.
Photo: BrianAJackson, Getty Images
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