Date of Award

Winter 12-15-2022

Document Type


Degree Name

Doctor of Medical Science (DMSc)


Department of Physician Assistant Medicine

First Advisor

Heather Rollins, DMSc, PA-C

Second Advisor

Erika Barber, M.D.

Third Advisor

Justin M. Gambini, DMSc, MSAPS, PA-C, DFAAPA



The prevalence of heart failure (HF) in the United States has been increasing for years. Many individuals, especially our older population, are ending up hospitalized, causing financial burden and worsened quality of life for our patients. HF is one of the leading causes of hospitalization and death in older adults in the United States.¹ Nearly one million patients are hospitalized due to HF every year and of those, many will be readmitted within a month of discharge.⁵ The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) and Heart Failure Society of America (HFSA) guidelines define HF as “a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood leading to cardinal manifestations of dyspnea, fatigue, and fluid retention and resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress.”⁶ Currently, the overall 5-year survival following the diagnosis of HF has been reported as approximately 50%.⁶ The management of HF is focused on the use of multiple medications including ACE inhibitors, beta blockers, diuretics, and sodium-glucose cotransporter 2 (SGLT2) inhibitors. When medication alone isn’t effective enough, patients with an ejection fraction equal or less than 35%, device usage such as implantable cardioverter defibrillators are considered. In addition to these treatments, many cardiologists recommend patients begin following a particular diet, such as the Mediterranean diet. It has been proved that the adherence to the Mediterranean diet is a useful tool in primary prevention of HF. However, since millions of Americans are already diagnosed with HF, it would be worth investigating if the same diet can be useful to prevent worsening of an already diagnosed HF. This diet might be helpful in slowing the progression of HF in individuals who are already being treated with the standard recommendations. It has been noted that if a patient has heart disease, their risk of future cardiovascular events may decrease by 72% with a Mediterranean diet and by 47% with exercise. ⁷ These outcomes can be noted through various mechanisms that will be discussed in this article, including decreasing obesity, hypertension, inflammation, diabetes, and dyslipidemia. These are known risk factors for worsening HF due to the increased strain they put on the heart. Learning more about the impact of diet on the bodies of those with HF, medical providers will expectantly feel more comfortable encouraging patients to focus on healthy living to slow progression of HF and decrease overall mortality risk.