Rural Cardiovascular Health in Missouri: Needs, Care Gaps, and Resources for a More Connected System.

Missouri's rural health needs are inseparable from cardiovascular health. Nearly one-quarter of Missourians live in nonmetro areas, where rural hospitals, clinics, community health centers, emergency medical services agencies, public health departments, and community organizations anchor care. Yet heart disease is the leading cause of death in Missouri; the 20 counties with the highest heart disease death rates are rural; and recent data show higher rural heart disease and stroke mortality than urban Missouri. Cardiovascular risk is shaped by clinical care, primary care access, transportation, insurance, broadband, food security, medication affordability, and specialty referral networks. Missouri has building blocks: critical access hospitals, rural clinics, federally qualified health centers, the Misouri Time Critical Diagnosis System for STelevation myocardial infarction (STEMI) and stroke, heart disease and stroke prevention program, workforce recruitment programs, and rural health transformation initiatives. This article proposes a rural cardiovascular agenda centered on prevention, urgent treatment, recovery, and community-level coordination.