Cardiovascular disease remains the leading cause of mortality in New Mexico, where access to timely acute cardiac care is substantially influenced by geography. Large portions of the state are characterized by vast distances, limited specialty infrastructure, and a predominantly rural and frontier population, exposing the limitations of population-density–based models of regionalized cardiovascular care. Drawing on clinical experience across both tertiary referral centers and rural hospitals and informed by publicly available state-level mortality and health infrastructure data, this Perspective examines “cardiology deserts” as a manifestation of system-level inequities in time-critical cardiac care delivery. The geographic clustering of 24/7 percutaneous coronary intervention–capable centers along major population corridors, particularly the I-25 axis, leaves extensive regions of the state reliant on prolonged interfacility transfer or delayed reperfusion strategies. Statewide cardiovascular mortality patterns parallel these spatial distributions, suggesting that geographic distance—independent of individual patient characteristics—functions as a clinically meaningful barrier to timely reperfusion, disproportionately affecting rural, frontier, Hispanic, and Native American communities. Addressing cardiology deserts in New Mexico requires a reframing of regionalized cardiac care that explicitly recognizes geography as a determinant of time-sensitive cardiovascular outcomes. Potential strategies include strengthening pharmaco-invasive reperfusion pathways, expanding telecardiology support for rural clinicians, and redesigning transfer networks to better reflect the realities of low-density practice environments. Without deliberate system-level adaptation, geographic distance will remain an underrecognized contributor to avoidable cardiovascular mortality in geographically expansive regions. In conclusion, aligning regional cardiac care models with geographic realities will be essential to reducing avoidable cardiovascular mortality in rural and frontier regions.
Preface: A Global Perspective on Geographic Inequity
This Perspective is informed by the author’s clinical experience as an internist who has practiced across both tertiary referral centers and rural hospitals in New Mexico over the past 5 years. Having trained and worked in healthcare systems with varying levels of resource availability, the contrast between advanced cardiovascular infrastructure concentrated in urban centers and limited access in rural and frontier regions of a high-income healthcare system is particularly striking. These experiences highlight how disparities in acute cardiovascular outcomes are often driven less by limitations in medical science than by geographic distance and delayed access to specialized care. In New Mexico, high-acuity interventional cardiac services are largely concentrated within major population corridors, while vast rural and frontier areas rely on small facilities with limited on-site specialty support. For clinicians practicing in these settings, the absence of real-time cardiology consultation and delayed access to definitive diagnostics or interventions introduces structural challenges to time-sensitive decision-making. This Perspective examines how the uneven geographic distribution of specialized cardiovascular resources contributes to measurable differences in time-to-care and outcomes, reframing cardiology “deserts” as a systems-level problem rooted in spatial organization rather than individual clinical capability. To further illustrate the real-world impact of geographic barriers, the next section presents clinical vignettes that contextualize population-level mortality patterns.
Clinical Witness: Illustrative Cases of Geographic Delay
Case 1: Delayed reperfusion due to transport constraints
A 68-year-old man presented to a frontier emergency department with acute-onset chest pressure. Initial electrocardiography demonstrated subtle inferior ST-segment abnormalities that were not immediately diagnostic, resulting in delayed recognition of acute myocardial infarction. In an urban setting, expedited cardiology consultation and transfer to a percutaneous coronary intervention (PCI)–capable center would typically occur within the recommended 90-minute window. In this rural context, thrombolytic therapy was deferred due to diagnostic uncertainty, and interfacility transfer was pursued.
Teleconsultation was initiated while awaiting air transport; however, adverse weather conditions grounded helicopter services, and ground transport was estimated to require approximately 3 hours. During this interval, the patient experienced progressive hemodynamic deterioration. Upon arrival at a tertiary center, the extent of myocardial injury was severe, and despite intervention, the patient did not survive. This case illustrates how transport logistics and delayed access to definitive care—rather than procedural failure—can determine outcomes in geographically isolated settings. ,
Case 2: Chronic ischemic injury and late presentation
A 72-year-old man presented in cardiogenic shock following a previously unrecognized myocardial infarction. The patient had limited access to cardiology services during the initial event and subsequently lacked longitudinal specialty follow-up for ischemic cardiomyopathy management. Over time, progressive ventricular remodeling and untreated heart failure culminated in advanced cardiogenic shock. This presentation reflects the cumulative impact of delayed diagnosis, limited specialty access, and fragmented longitudinal care in rural and frontier regions.
Together, these cases illustrate how geographic isolation can influence both acute reperfusion timelines and long-term cardiovascular outcomes through mechanisms of delayed access rather than individual clinical decision-making.
In geographically expansive regions such as rural New Mexico, acute myocardial infarction represents not only a medical emergency but also a challenge of timely access to definitive care. Contemporary cardiology emphasizes rapid reperfusion within a 90-minute window; however, achieving this benchmark remains difficult in low-density regions with limited specialty infrastructure. As a result, time-to-care—rather than therapeutic capability—often becomes the dominant determinant of outcome. , New Mexico’s cardiovascular care infrastructure is largely centralized along major population corridors, particularly the I-25 axis, reflecting population-density–based optimization of healthcare resources. While this model improves efficiency for urban populations, it introduces systematic delays for residents of rural and frontier counties, where proximity to PCI-capable centers is measured in hours rather than minutes. These geographic constraints disproportionately affect communities with higher burdens of cardiovascular risk and limited access to specialty services. This Perspective does not present a registry-based outcomes analysis, but rather synthesizes spatial infrastructure patterns, transport realities, and established time-outcome relationships to highlight a system-level gap in care delivery. Cardiology “deserts” are examined as a manifestation of inequities arising from the spatial organization of cardiovascular care rather than deficiencies in clinical knowledge or intent. Understanding these dynamics is essential for developing pragmatic regional strategies that improve time-sensitive cardiovascular care without necessitating universal on-site interventional capacity. To illustrate the spatial distribution of cardiac care resources, Table 1 and Figure 1 summarize the locations of primary PCI-capable and elective cardiac catheterization centers across New Mexico.
Table 1
Geographic distribution of cardiac catheterization centers in New Mexico
| Region | City | Facility name | Catheterization capability |
|---|---|---|---|
| Central | Albuquerque | Lovelace Heart | Primary PCI Capable (24/7) |
| Central | Albuquerque | Presbyterian | Primary PCI Capable (24/7) |
| Central | Albuquerque | UNM | Primary PCI Capable (24/7) |
| Central | Albuquerque | NM VA Medical Center | Elective-only Cardiac Catheterization |
| North | Santa Fe | Christus St Vincent | Primary PCI Capable (24/7) |
| South | Las Cruces | Memorial | Primary PCI Capable (24/7) |
| South | Las Cruces | MountainView | Primary PCI Capable (24/7) |
| South | Las Cruces | ASC of Heart Institute | Elective-only Cardiac Catheterization |
| Northwest | Farmington | San Juan Regional | Primary PCI Capable (24/7) |
| Southeast | Roswell | Eastern NM | Primary PCI Capable (24/7) |
| Southeast | Carlsbad | Carlsbad Medical | Primary PCI Capable (24/7) |
| Southeast | Hobbs | Covenant Health | Primary PCI Capable (24/7) |
| South | Alamogordo | Christus Health | Elective-only Cardiac Catheterization |
| Central | Rio Rancho | Presbyterian | Primary PCI Capable (24/7) |
| East | Clovis | Presbyterian | Primary PCI Capable (24/7) |
PCI = percutaneous coronary intervention; NM = New Mexico; VA = Veterans affairs.
Geographic distribution of primary PCI-capable and elective cardiac catheterization centers in New Mexico. Hospitals offering 24/7 primary percutaneous coronary intervention (PCI) and those limited to elective-only cardiac catheterization are shown. Major population centers and highways, including Interstate 25 (I-25), are labeled to provide geographic context. This figure illustrates the spatial distribution of cardiac catheterization infrastructure and does not reflect patient volume, interfacility transfer patterns, or clinical outcomes.
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