Date of Award

Spring 5-2025

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Metzger, Jay

Keywords

HFrEF, GDMT optimization, rural disparities, underserved populations, heart failure hospitalizations

Abstract

Heart failure with reduced ejection fraction (HFrEF) continues to be a substantial public health challenge, thus optimal management through guideline-directed medical therapy (GDMT) continues to be vital. Evolving GDMT has established four pillars of first-line optimal treatment with expeditious and maximized titration of established target dosing of pillar medications. GDMT has been shown to decrease mortality among HF patients. Although continuing advancements in treatment efficacy prevail, studies demonstrate that vulnerable populations, particularly rural, Black and Hispanic individuals, exhibit significantly lower rates of GDMT optimization, leading to increased hospitalization and mortality. This literature review evaluates disparities in GDMT implementation among urban, rural and underserved populations, and underlines how geographical isolation, socioeconomic factors, and demographics influences treatment outcomes. This literature review reveals that remote monitoring and telemedicine, particularly in rural settings, show the potential to mitigate these disparities through enhanced access to care. Searches were concluded using the electronic databases Pubmed and Embase yielding 13 articles of significance. The findings demonstrate a notable difference in the optimization of GDMT when comparing urban vs rural or underserved populations and includes statistically significant disparities with suboptimal GDMT in rural populations. This is compounded by higher HF hospitalizations in underserved populations regardless of geography, underscoring the necessity of a multidisciplinary model. Despite established GDMT, multifactorial disparities exists between urban, rural, and underserved populations with regards to HFrEF treatment. While additional research is needed, increased engagement and fluency amongst primary care providers as well as remote technologies may bridge the treatment gap.

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