Why primary care is the front line in the war against cardiovascular disease

For decades, the landscape of primary care has been defined by the annual physical—a snapshot in time where blood pressure is measured, labs are drawn, and lifestyle advice is dispensed. However, as the medical community grapples with a rising tide of chronic illness, it is becoming increasingly clear that the traditional model of episodic care is insufficient to combat the leading cause of death in the United States. Cardiovascular disease remains a quiet crisis, one that often builds without symptoms until it manifests as a catastrophic event. For primary care physicians, the challenge is no longer just identifying risk within the four walls of the exam room, but managing it during the hundreds of days between visits.

The disconnect: Awareness vs. action

The scale of the cardiovascular challenge is immense. Heart disease has been the leading cause of death for Americans for over a century. Yet, according to Hello Heart’s 2026 Heart Health Matters Report, a survey of 400 benefits leaders across the public and private sectors, there is a startling lack of awareness; only 51% of respondents were aware that heart disease is the leading cause of death. The report further highlights a pronounced "action gap" in the corporate and insurance sectors. While more than 9 in 10 health benefit leaders identify heart disease as a major cost concern, only about one-third rank its prevention as a top priority.

This disconnect has significant financial implications for the health care system at large. The report notes that people living with heart disease or key risk factors generate an average of $9,300 in annual medical costs, a figure largely driven by preventable acute care events. Edo Paz, MD, senior vice president of medical affairs at Hello Heart and a practicing cardiologist at White Plains Hospital, notes the danger of this reactive approach.

“Heart disease is already one of the biggest cost centers in healthcare, but too often it is treated as an inevitable problem instead of a preventable one,” says Paz. “Heart disease is frequently deprioritized in favor of more visible cost pressures, even though early prevention delivers stronger savings and outcomes.”

For primary care, this means the burden of prevention is higher than ever. The Heart Health report points out that cardiovascular risk builds quietly, and costs tend to spike only after a heart attack or stroke occurs—at which point the most critical opportunities for prevention have already been missed.

The critical role of the primary care physician

Primary care is the natural home for cardiovascular prevention. It is the setting where subclinical risk can be identified and managed before it escalates into a major problem.

Paz says that identifying these risks early is essential for both the patient's health and their day-to-day productivity.

“Primary care plays a critical role in identifying cardiovascular risk before it becomes a medical emergency,” Paz says.“Conditions like uncontrolled blood pressure often have no obvious symptoms, yet they quietly impact energy, focus, and daily functioning. Earlier identification and management of risk factors requires a lot of both doctors and patients, including an understanding of the short- and long-term benefits. Reinforcing self-management between visits, and using home monitoring and trend data allows clinicians to intervene earlier and help patients feel better long before a heart attack or stroke occurs.”

The impact of unmanaged heart health extends beyond the clinical setting into the workplace. According to the Heart Health report, 87% of employer leaders believe that the indirect costs of unmanaged heart disease—such as lost productivity, burnout, and missed workdays—actually exceed direct medical claims.

“It’s obvious that an event like a heart attack or a heart-related hospitalization will lead to missed days at work,” Paz says.“But cardiovascular risk can quietly erode day-to-day functioning and performance long before a catastrophic event occurs.”

Closing the gender gap in cardiovascular care

One of the most pressing challenges for PCPs is the persistent disparity in outcomes for women. The Heart Health report reveals that only 47% of benefit leaders are aware that heart disease is the leading cause of death for women. Women continue to die from heart attacks at up to twice the rate of men, a statistic driven by clinical bias, lack of awareness regarding non-traditional symptoms like jaw pain and nausea, and sex-specific risks associated with pregnancy and menopause.

Paz views primary care as the primary vehicle for correcting this imbalance.

“Women’s cardiovascular risk remains under-recognized, and primary care is where that can change,” Paz says.“Clinicians need better support to identify both general and sex-specific risk factors and warning signs, paired with tools that help women manage risk consistently between visits. Women need access to daily prevention tools and education about their unique risks, which are impacted by life events like pregnancy and menopause, and their potential heart attack symptoms, which can differ from men’s. I also encourage all clinicians and healthcare leaders to stay informed on women’s heart health risk via Continuing Medical Education, dialogues with colleagues, reading the latest clinical literature, and attending events like Hello Heart’s Women’s Heart Health Summit.”

Bridging the 360-day gap

Perhaps the greatest hurdle in cardiovascular prevention is the fact that risk is not a static data point captured once a year; it is a cumulative result of daily behaviors. The Heart Health report points out that nearly half of patients treated for hypertension are nonadherent to their medications, a trend that accounts for one in five emergency department visits and $3,900 in avoidable annual costs per person.

Traditional primary care workflows often struggle to address this "between-visit" reality. When asked what specific actions would have the biggest impact on closing the prevention gap, Paz points to the necessity of extending support beyond the clinic.

“The biggest opportunity is pairing earlier risk stratification with support that extends beyond the exam room,” he says.“Cardiovascular risk doesn’t exist only during annual visits; it builds every day. Heart attack and stroke prevention only works if patients are supported the 360+ days they’re not in the clinic. People need self-management tools they can use from anywhere to track and manage their heart health and stay adherent to their medications and treatment routines — because behavior change is hard.”

This is where digital and AI-enabled tools become essential partners for primary care. By combining clinical judgment with longitudinal home data—such as blood pressure trends and medication adherence—physicians can intervene with greater confidence and precision.

AI as a force multiplier, not a replacement

A common concern among physicians is that new digital tools will increase "inbox burden" or replace the human element of care. However, the data from the Heart Health report suggests that 93% of leaders believe members would be comfortable using AI-powered tools for coaching and reminders. Paz says that when integrated correctly, these tools actually strengthen the patient-physician relationship.

“AI works best as a between-visit extension of the care team, not a replacement for clinicians,” Paz says.“These tools help patients understand their numbers, stay adherent, and know when to seek care, while bringing clean, actionable trend data into the visit. That strengthens the patient–physician relationship by making visits more informed, more efficient, and more focused on shared decision-making. The best digital health tools are complementary and additive to clinical care. They should not be redundant nor should they replace expert human care.”

Another effective model involves delegating the "everyday work" of management to these tools while the PCP remains the pilot of clinical decisions.

“AI-enabled coaching, reminders, and medication support can address adherence barriers between visits and answer common questions, while driving patients back to primary care when a clinical change is needed,” says Paz.“That improves adherence without adding visits or inbox burden, and informs clinical visits with more reliable and robust data.”

Aligning incentives for prevention

For this continuous care model to become the standard, the health care system must align incentives so that PCPs are rewarded for prevention rather than just reaction. Value-based payment programs and Medicare Advantage are already moving in this direction by focusing on blood pressure control and reduced acute care utilization.

Furthermore, data from organizations like Aon shows that digital health participation can actually increase primary care utilization while lowering overall costs for employers and health plans.

“Primary care physicians, health plans, and employers should be incentivized to implement preventive care programs, and digital health programs, like Hello Heart, can help,” Paz says.

Studies show that digital tools can help reduce costs for employers and health plans while increasing reimbursable visits and patient engagement for primary care physicians.

A scalable future for heart health

The path forward for primary care involves moving away from the "one-off visit" mentality toward a sustainable, continuous care model. The report is clear that the cost crisis can be turned around, noting that up to 80% of heart attacks and strokes are preventable through earlier intervention, improved adherence, and lifestyle changes. To achieve this at scale, PCPs must embrace tools that allow for remote monitoring and targeted clinical escalation.

“We can’t scale prevention through office visits alone,” says Paz. “The future is a continuous care model that combines remote monitoring, asynchronous coaching, and targeted clinical escalation for patients with the highest risk levels. When patients are supported daily and clinicians receive concise, meaningful trend data, cardiovascular risk management becomes scalable, sustainable, and far more effective over time.”

For the primary care physician, the message is clear: the technology and the data now exist to close the gap between clinical awareness and life-saving action. By investing in prevention today, PCPs can protect the lives of their patients and lead the charge in creating a more resilient health care system.

“Preventable cardiac events are placing unsustainable strain on organizations and individuals alike,” Paz says.“The good news is that when employers and health plans invest earlier, they can protect lives, reduce costs, and support healthier, more resilient people.”