Heart disease has remained the leading cause of death in the United States for decades, despite only around half the nation being aware of it. But according to Paula Banahan, President and Chairperson of the Arizona Heart Foundation, it is often discussed as though it were an unpredictable force rather than a condition shaped by identifiable risks and missed opportunities for early detection. “Advances in emergency cardiac care have saved countless lives,” she says. “But the public narrative still centers on crisis response instead of prevention. That imbalance has consequences.”

One of the most difficult realities of cardiovascular disease, notes Banahan, is how frequently it goes undetected until a serious event occurs. “In many cases, sudden cardiac death is the first outward sign of underlying heart disease,” Banahan says. “This pattern reinforces a sense that cardiac events arrive without warning, when in fact the warning signs often exist long before symptoms appear.” The problem is not a lack of medical knowledge, but a lack of systems and habits that prioritize early insight.

This normalization of cardiac emergencies as unavoidable has quietly shaped behavior. Preventive testing is often deferred until symptoms emerge, while the absence of discomfort is mistaken for the absence of risk. Over time, prevention becomes optional rather than expected. Changing that mindset requires both access to practical tools and consistent education about why early detection matters.

For Banahan, prevention is not an abstract concept. It is a discipline rooted in clinical experience and reinforced by decades of real-world outcomes. A registered nurse by training, Banahan has spent much of her career focused on cardiovascular risk and the gaps that allow disease to progress silently.

At the center of that gap is a healthcare structure that often places prevention at a disadvantage. “Diagnostic testing typically follows symptoms, not risk,” she notes. “Insurance reimbursement models tend to favor intervention over early detection, while high deductible plans can leave individuals facing substantial out-of-pocket costs before coverage applies.”

From Banahan’s perspective, this misalignment extends beyond health outcomes. Preventive care is also a financial issue. According to her, the cost of managing heart attacks, strokes, and long-term disability can far exceed the cost of early imaging and monitoring. Yet, she believes that the system rarely reflects that logic in how services are delivered or prioritized.

The Arizona Heart Foundation has worked to address this disconnect through a dual approach that separates screening from diagnosis while keeping both accessible. Community-based ultrasound screenings are offered through the Foundation’s School of Ultrasound, where advanced students perform exams under established protocols and qualified supervision. These screenings are designed to identify abnormalities without issuing diagnoses, ensuring that participants receive meaningful information they can share with their physicians.

When diagnostic exams are required, the Foundation operates a low-cost imaging center that performs physician-ordered studies using credentialed sonographers and physician interpretation. The distinction between screening and diagnostic care is intentional, reflecting different clinical standards while preserving clarity and trust.

Accessibility is not limited to patients. The imaging center also provides physicians with a flexible option to see patients closer to where they live. “In large metropolitan areas where travel time can discourage follow-through, proximity becomes part of prevention,” says Banahan. “Reducing logistical friction increases the likelihood that recommended tests are completed rather than postponed indefinitely.”

Equally important is the simplicity of the experience itself. According to Banahan, cardiac ultrasound exams are noninvasive and typically completed within an hour. Participants are not required to perform tasks during the exam, and private rooms are available when appropriate. Reports, she notes, are generally delivered within seven to ten days, allowing individuals and their providers to make timely decisions.

While access matters, Banahan consistently returns to education as the foundation of prevention. She speaks regularly in community settings, addressing topics such as cholesterol, heart disease, and how cardiovascular risk can differ between men and women. She also speaks in schools, viewing early education as a way to shape long-term health behavior.

Those school visits often create ripple effects. “Children share what they learn at home, sparking conversations that may not have happened otherwise,” Banahan says. “Habits and assumptions are easier to influence before they are fully formed, and we see these early discussions as essential to shifting how heart health is perceived across generations.”

The long term goal is not simply to increase the number of tests performed. It is to reframe heart disease as a condition that can often be identified earlier and managed more effectively when prevention is treated as routine care rather than an exception.

“Heart disease is common, but its inevitability is a belief, not a diagnosis,” Banahan states. “Changing that belief may be one of the most important steps toward reducing the toll cardiovascular disease continues to take on families and communities across the country.”