Abstract

Medically supportive food and nutrition education improves health and reduces re-admission for safety-net patients hospitalized with heart failure exacerbation: A pilot randomized controlled trial

Andrea Pedroza-Tobias¹, Rita Nguyen², Edward Frongillo³, Asher O'Donnell⁴, Cady Smith⁵, Lizet Campos⁴, Binh An Phan⁶, Sheri Weiser⁴, Kartika Palar⁴ (1)Institute for Global Health Sciences, University of California San Francisco, (2)California Department of Public Health, (3)Arnold School of Public Health, University of South Carolina, (4)Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, Department of Medicine, University of California San Francisco , (5)University of California Davis, (6)Division of Cardiology, San Francisco General Hospital, Department of Medicine, University of California San Francisco

APHA 2022 Annual Meeting and Expo

Introduction. Medically appropriate diet in patients with heart failure (HF) is critical for the management of their disease. Limited access to economic, social, and educational resources can result in a low-quality diet. Low-quality diet is associated with reduced HF quality-of-life, increased hospital admissions, and premature mortality. The Cardiac Recovery through Dietary Support (CaRDS) pilot randomized trial aimed to investigate the preliminary impact of medically tailored meals, groceries and nutrition education on HF quality-of-life and hospital re-admission in a safety-net hospital setting.

Methods. The CaRDS trial randomized 161 patients hospitalized with HF exacerbation post-discharge to receive either 1) five months of medically tailored meals and groceries alongside monthly nutrition education (intervention; n=79), or 2) standard of care (control; n=82). Mixed-effects models evaluated the change in HF quality-of-life (primary outcome) at one and five months, compared to baseline, using the Kansas City Cardiomyopathy Questionnaire (KCCQ) (scale 0-100, higher scores, better quality-of-life). A Cox proportional-hazards model estimated the impact of the intervention on hospital readmission.

Results. The overall KCCQ score, clinical summary score, and physical and total symptom domains were 10-15 points higher – a clinically significant difference – in the intervention compared to the control group, at one and five months (P<0.05). The intervention group had a lower hazard of hospital readmission at 5 (HR: 0.54. 95%CI: 0.32,0.93) and 9 (HR: 0.59 95%CI: 0.37,0.96) months, compared with the control group.

Conclusions. Providing medically supportive food and nutrition education has the potential to improve health and prevent hospital readmission in safety-net patients with HF.

Trial registration: ClinicalTrials.gov NCT03759925