Access to heart disease and stroke care in Tennessee.

: Tennessee is ranked fourth-worst in the United States for deaths caused by stroke and third-worst in the nation for cardiovascular deaths. Two recent surveys provide information about the geographic distribution of hospital-based, primary and secondary care promotion, and of emergency medical services for these disease conditions. This article is a synthesis of selected findings from these surveys to identify priority populations for interventions to reduce cardiac and stroke mortality in Tennessee. Twenty-three counties have a medical facility with a formal clinical pathway or system for implementing cardiovascular disease prevention strategies. Sixty-three of the state's 95 counties have no designated specialty center for an EMS service to transport cardiac and stroke patients. Fifty-six counties, comprising 38 percent of the state's population, lie between 20 and 50 miles from the nearest state-of-the-art stroke care. Twenty-one counties, containing nearly 10 percent of the state's population, are greater than 50 miles from advanced stroke care facility. Some health districts are faring better than the state proportion (86.8 percent) for people indicating they would call 911 for a suspected cardiac or stroke emergency, while many are performing much poorer. The Shelby district (Memphis) is much higher (p < 0.01), while Madison and South Central districts are well below the state's prevalence (p < 0.001). The fact that these "less-likely-to-call-911" areas are also in mostly rural settings poses priority challenges for public education. To combat this trend, coordinated efforts are in progress to incentivize the development of cardiac and stroke centers or, alternatively, the formation of regional collaborative networks affiliated with a specialty center.