The Intersection of Rurality With Female Sex and Gender in Heart Failure

BACKGROUND: Despite the increasing recognition of heart failure (HF) as a critical public health issue for both rural populations and women, the intersection of rurality and female sex in HF remains underexplored. OBJECTIVE: The objective of this scoping review was to synthesize the evidence on the intersection of rurality with female sex and gender in HF, examining how individual, interpersonal, organizational, or community factors influence the experience, management, and outcomes of HF in women. METHODS: Using the PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature databases, a literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Findings were organized by level of the social-ecological model (SEM). RESULTS: Among the 1119 articles reviewed, 11 original studies met inclusion criteria, and their results were synthesized. Rural women were found to be at higher risk of developing HF when compared with their male and urban counterparts and tended to have worse outcomes, including higher rates of hospitalizations and mortality. Rural women were also less likely to receive evidence-based care and used healthcare services less. CONCLUSIONS: Findings underscore the intricate interplay between SEM factors that influence HF outcomes in rural women. While highlighting the disparities this demographic group faces, the findings also emphasize the urgency for targeted interventions to address these multifaceted disparities. Future research should further explore the interactions between individual, interpersonal, organizational, and community factors to improve the care and outcomes of rural women living with HF.