Cardiologist visits and tests make no difference in managing heart disease

You might assume that men and women who live in urban areas have easier access to “high-quality” medical care.  And that more health care means better health. If that’s all true, then urban dwellers should live longer, healthier lives…right?

Of course, it doesn’t really work that way.

In fact, Canadian researchers recently discovered that access to health care has very little impact on men and women with serious heart disease. I’ll tell you more about this fascinating and unorthodox study in a moment. But first, let’s back up.

Sometimes, it seems like the United States of America is two different countries.

For example, the map of United States by congressional district after this past midyear election looked like a sea of red for one party. Then, there were about a dozen little, blue dots for the other party, mostly scattered in the northeast and the upper, mid-western “rust belt.” And some clung to the far edges of the West coast.

Of course, these political voting patterns clearly relate to population density. In rural areas with fewer people, we see more red. And in the cities and suburbs with higher-density populations, we see the little blue dots.

But the U.S. wasn’t always so clearly divided…

When the U.S. was founded, there was a better balance between the cities and the country. Most people were farmers who grew their own foods. And farmers needed to be connected directly to the land. But today, modern technology and transportation have resulted in a total disconnect from the land for increasing numbers of people.

Thomas Jefferson’s vision for the new United States was that of an agrarian democracy with people living on the land having a stake in the progress, prosperity, and prospects of the country. He warned of “rule by the urban mob.” And others picked up on this concern with the “tyranny of the majority.”

This major theme recurred like clockwork in U.S. elections of 1800, 1820, 1840, 1860, 1880, and 1900. During the Civil War (1861-65) and its long aftermath, the rural, agricultural areas in the South clashed with the dominant, urbanized, industrialized areas of the North.

We even see this cultural clash reflected in children’s tales about the “country mouse and the city mouse.” By the beginning of the 20th century, during WW I, a popular song by Al Jolson went, “How ya gonna keep ‘em down on the farm, after they’ve seen Paree.”

And by the 20th century, the majority of Americans did not keep themselves to down on the farm. The great urbanization of America brought us more traffic, pollution, and stress. Which, in turn, brought us more health problems associated with these factors.

On the flip side, as I mentioned above, some would argue men and women who live in urban and suburban areas have better access to health services. And, of course, Obamacare made sure this assumption held true…

But last year, Obamacare wiped out the availability of health insurance options in many rural counties in the U.S. In fact, of the roughly 2,500 counties in the U.S. served by the federal exchanges, 58 percent now have plans offered by just one or two insurance carriers. Since then, a dozen rural hospitals around the country had to close their doors.

Without a doubt, big government likes its cities. And it pays more attention to building so-called “healthy cities.” In fact, last year, Obama’s Secretary of Health and Human Services accepted a last-minute invitation to speak at a politically correct academic conference on “healthy cities” at U Penn, my alma mater. (Ironically, during the same week, she had already skipped out on Congressional hearings about the Affordable Care website disaster-in-progress because she said she was “too busy.”)

So, yes, men and women living in rural areas have less access to health care. (Thanks in large part, most recently, to the Affordable Care Act). But does that mean the care they do receive is sub-standard compared to the care offered in urban areas? And furthermore, does it mean these men and women don’t live as long as their city-dwelling peers, as a result?

As I mentioned earlier, researchers recently set out to answer some of these important questions.

For this study, they compared health outcomes for about 38,000 Canadian patients with coronary artery disease (CAD) who lived in rural versus urban areas. Ninety percent of the patients lived in urban areas. And just 10 percent lived in rural areas. Next, the researchers measured three aspects of participants’ healthcare: the number of doctor visits, the amount of medication use, and the amount of diagnostic tests.

During the year following their CAD diagnosis, patients living in the country made fewer physician visits than those living in the city. In fact, they made half the number of visits to cardiologists. And significantly fewer visits to primary care and internal medicine physicians as well. They were also less likely to have tests to measure cholesterol or blood sugar. And last (but certainly not least), they were also less likely to receive statin drugs.

However, their rates of suffering an actual heart attack, being hospitalized, or dying were similar to those city dwellers who made more frequent trips to the physician, had more testing, and took more drugs.

With these results, the Canadian researchers questioned the current emphasis in cardiology practice on frequent lab-based testing and hospital-based care.

In other words, if seeing the doctor more frequently, taking more drugs, and getting lots of tests doesn’t help the patient live longer, why are we doing it? The authors caution that before we measure quality of healthcare delivery for heart disease, we should consider that more is not always better.

This finding may surprise the apparently fraudulent architects of Obamacare. But it turns out that rural dwellers are just as well off, even without their version of healthcare “reform.”

And, according to this study, you’ll do just as well skipping the cardiologist visits, expensive tests, and dangerous drugs no matter where you live.

Given the misplaced priorities and toxic drugs for “managing” heart disease, it should really come as no surprise that more of this kind of “care” appears to be futile and useless.

There are, however, a number of safe, natural approaches to heart health that are available to “city folk” and “country folk” alike. I outlined many of these solutions in my special report The Insiders’ Secret to Conquering High Blood Pressure and Protecting Your Heart.

Subscribers to my Insiders’ Cures newsletter can download and view this report for free by logging on to my website,  (And if you’re not already a subscriber, the website also offers all the information you need to sign up today.)


1.  “Cardiovascular Quality and Outcomes,” Circulation published on-line, October 28, 2014