Opinion: 46% of U.S. counties don’t have a cardiologist. ARPA-H’s new agentic AI program could bring them specialized care

When my 14-year journey to train as a heart failure cardiologist finally concluded, I naturally assumed the hardest time was behind me. But in my first job I found myself working as the only cardiologist in a county of more than 150,000 people in rural North Carolina at a hospital actively undergoing bankruptcy.

This experience opened my eyes to the increasing gap in mortality between urban and rural areas in the United States, driven by chronic heart disease. Yet poor care is not just restricted to health care deserts: An upcoming national analysis from my team revealed that only 2.5% of American patients are on lifesaving recommended medications. Any solution that relies on clinicians is bound to fail, however, given that 46% of counties in the United States don’t have a single cardiologist.

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