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Home-Delivered Meals Help Keep Patients out of the Hospital: In a pilot study, a diet of tasty, low-sodium meals made a difference in heart failure rehospitalizations.

Could tasty, home-delivered meals for patients with heart failure keep them out of the hospital? A small pilot study presented at the Heart Failure Society of America 2017 Scientific Meeting suggests that it can.

The trial recruited 66 patients with acute decompensated heart failure discharged from three hospitals, and randomized them to usual care or usual care plus home delivery of prepackaged low-sodium meals for four weeks. They were then followed for two months. Although the specially prepared meals didn't significantly improve quality of life scores, they did reduce the risk of hospitalization and number of hospitalization days, leaving the researchers satisfied that a larger randomized trial is warranted.

No Salt, No Taste. A low-sodium diet is a necessary component of heart-failure therapy. However, patients often find low-sodium and sodium-free foods lacking in flavor. Thus, they lose interest in food and stop eating. By consuming too few calories to meet their daily needs, they miss important micronutrients and become malnourished.

Insufficient calorie consumption also causes heart failure patients to lose weight. This can accelerate decline in patients with the severe form of body wasting known as cardiac cachexia, in which the body consumes its own fat and muscle.

"Food As Medicine" Theory Tested. The Geriatric Out-of-Hospital Randomized Meal Trial in Heart Failure (GOURMET-HF) tested whether improving the flavor of foods would encourage patients to eat better and feel better. The researchers based their meals on the sodium-restricted Dietary Approaches to Stop Hypertension (DASH) diet, altering the recipes to ensure meals included no more than 1,500 mg of sodium a day. All recipes were pre-tested to ensure they were tasty. Potassium levels were customized to individual needs.

Patients were given a variety of foods to choose from. Orders were delivered weekly for four weeks. The patients were discouraged from supplementing their diet with other foods, but they were allowed some leeway for holidays and special events. Surprisingly, 76 percent of patients stuck with the meal plan at least 80 percent of the days.

Not Feeling Better, but Doing Better. The primary endpoint was improvement in quality of life as scored by the Kansas City Cardiomyopathy Questionnaire (KCCQ), which was administered prior to enrollment and after completing the trial. The scores rose significantly in the period between hospital discharge and the end of the four-week meal-delivery period.

KCCQ scores reflecting symptom status and physical limitations rose 15 points among those who received the meals and 10 points in those who received only usual care. However, this difference was not statistically significant.

End Result. Although the trial only marginally met its primary goal of improving quality of life, the researchers discovered that eating better meals on a regular basis helped keep heart failure patients out of the hospital. During the three-month trial period, patients on the DASH diet spent a total of only 17 days in the hospital, compared with 55 days for those who received usual care.

"Overall, people liked the diet and were adherent. The overall cost for four weeks was $650 [per person]. It's not inexpensive, but compared with a day of heart-failure hospitalization, it has the potential to be cost-effective," the lead researcher told the audience.
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Title Annotation:CARDIOVASCULAR MEDICINE
Publication:Duke Medicine Health News
Date:Jan 1, 2018
Words:528
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