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People living in rural areas who experienced a heart attack were nearly three times more likely to die before reaching hospital care, compared with those living in large metropolitan areas, according to new, independent, preliminary research presented at the American Heart Association's Scientific Sessions 2026, held Nov. 6–9 in Chicago.

In the U.S., someone experiences a heart attack every 40 seconds, according to the American Heart Association's 2026 Heart Disease and Stroke Statistics, with about 50% of fatal heart attacks occurring outside of the hospital.

Previously, there were limited data on exactly which populations and demographics were at greater risk of death before reaching hospital care. This study explored participants' location at the time of heart attack and death, distance to the nearest hospital and whether deaths differed according to their age, sex, race, Hispanic ethnicity and urban or rural residency.

"Getting emergency care as soon as possible can make a major difference in a life-threatening situation," said study author Darshan Shivanne Gowda, M.B.B.S., a medical student at Hassan Institute of Medical Sciences in Karnataka, India.

"We found that people who live in rural areas and certain other populations were more likely to die before receiving urgent care for a heart attack that would improve their chances of survival."

"The message for patients and families is simple: know the warning signs of a heart attack and do not wait to seek help," Gowda said.

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