In the Journals

Home-delivered, low-sodium meals may prove useful after HF discharge

After discharge, home-delivered, low-sodium meals did not improve disease-specific quality of life among adults with HF, but the meal plan may yield beneficial effects on clinical status and 30-day readmissions, according to results of the GOURMET-HF study.

“Home delivery of meals was feasible, participants largely adhered to the diet and diet-related adverse events were uncommon. Although not meeting its primary outcome, this pilot study demonstrated trends for efficacy in several domains important to recently hospitalized patients with HF and their providers. These outcomes included symptoms and physical limitations related to HF, as well as rehospitalization burden,” Scott L. Hummel, MD, MS, assistant professor at University of Michigan Frankel Cardiovascular Center and director of the heart failure program at Ann Arbor Veterans Affairs Health System, and colleagues wrote in Circulation: Heart Failure.

After discharge for HF, 66 patients were randomly assigned to usual care or to 4 weeks of home-delivered DASH diet meals, limited to 1,500 mg of sodium per day and increased intake of whole grains, fruits, vegetables, nuts and legumes. Meals were delivered once a week by Mom’s Meals NourishCare. Patients could choose their menu ahead of time, and received three daily meals, snacks and some beverages. Total daily calorie intake was 2,100. Both groups were provided with information recommending a low-sodium diet. The patients’ mean age was 71 years, 30% were women and mean ejection fraction was 39%.

At 4 weeks, the primary outcome of between-group change in Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score was similar in both groups, at a mean change of 43 to 53 in the usual-care group vs. 46 to 59 in the meal-delivery group (P = .38). However, the meal-delivery group had a significantly greater increase in KCCQ summary score compared with usual care from baseline to 4 weeks (P = .053).

In other secondary findings, potentially diet-related adverse events were uncommon. Three adverse events occurred in the meal-delivery group — presyncope, acute renal insufficiency and hyperkalemia — and no events occurred in the usual-care group. The researchers noted that the adverse events were unrelated to the diet and no event resulted in hospitalization.

Changes in serum potassium, serum creatinine or systolic BP from baseline to 4 weeks were not significant in either group.

HF readmissions within 30 days were lower in the meal-delivery group, at 11% vs. 27% (P = .06). During the first 4 weeks after discharge, the meal-delivery group spent 17 cumulative days rehospitalized, compared with 55 days in the usual-care group (P = .055).

“[The] GOURMET-HF pilot study suggests that postdischarge nutritional support has the potential to improve HF symptoms and reduce readmissions. Larger studies are warranted to explore these concepts further,” Hummel and colleagues wrote.

In a related editorial, Linda van Horn, PhD, RDN, and Mark D. Huffman, MD, MPH, from the department of preventive medicine at the Feinberg School of Medicine, Northwestern University, wrote: “Although the GOURMET-HF pilot trial may have been underpowered to demonstrate differences in key outcomes, if they do exist, the signal on rehospitalization is promising.”

Van Horn and Huffman also noted that further research is warranted.

Diet interventions for malnourished patients with HF may be a safe and ultimately cost-effective strategy to improve both the quality of life and the quality of meals of these patients,” van Horn and Huffman wrote. – by Melissa J. Webb

Disclosures: The study was funded by the NIH/National Institute of Aging and PurFoods, LLC. Hummel and colleagues no relevant financial disclosures. Huffman reports he has received support from the American Heart Association, AstraZeneca, Verily and the World Heart Federation’s Emerging Leaders program, which is supported by Boehringer Ingelheim and Novartis. Van Horn reports no relevant financial disclosures.

After discharge, home-delivered, low-sodium meals did not improve disease-specific quality of life among adults with HF, but the meal plan may yield beneficial effects on clinical status and 30-day readmissions, according to results of the GOURMET-HF study.

“Home delivery of meals was feasible, participants largely adhered to the diet and diet-related adverse events were uncommon. Although not meeting its primary outcome, this pilot study demonstrated trends for efficacy in several domains important to recently hospitalized patients with HF and their providers. These outcomes included symptoms and physical limitations related to HF, as well as rehospitalization burden,” Scott L. Hummel, MD, MS, assistant professor at University of Michigan Frankel Cardiovascular Center and director of the heart failure program at Ann Arbor Veterans Affairs Health System, and colleagues wrote in Circulation: Heart Failure.

After discharge for HF, 66 patients were randomly assigned to usual care or to 4 weeks of home-delivered DASH diet meals, limited to 1,500 mg of sodium per day and increased intake of whole grains, fruits, vegetables, nuts and legumes. Meals were delivered once a week by Mom’s Meals NourishCare. Patients could choose their menu ahead of time, and received three daily meals, snacks and some beverages. Total daily calorie intake was 2,100. Both groups were provided with information recommending a low-sodium diet. The patients’ mean age was 71 years, 30% were women and mean ejection fraction was 39%.

At 4 weeks, the primary outcome of between-group change in Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score was similar in both groups, at a mean change of 43 to 53 in the usual-care group vs. 46 to 59 in the meal-delivery group (P = .38). However, the meal-delivery group had a significantly greater increase in KCCQ summary score compared with usual care from baseline to 4 weeks (P = .053).

In other secondary findings, potentially diet-related adverse events were uncommon. Three adverse events occurred in the meal-delivery group — presyncope, acute renal insufficiency and hyperkalemia — and no events occurred in the usual-care group. The researchers noted that the adverse events were unrelated to the diet and no event resulted in hospitalization.

Changes in serum potassium, serum creatinine or systolic BP from baseline to 4 weeks were not significant in either group.

HF readmissions within 30 days were lower in the meal-delivery group, at 11% vs. 27% (P = .06). During the first 4 weeks after discharge, the meal-delivery group spent 17 cumulative days rehospitalized, compared with 55 days in the usual-care group (P = .055).

“[The] GOURMET-HF pilot study suggests that postdischarge nutritional support has the potential to improve HF symptoms and reduce readmissions. Larger studies are warranted to explore these concepts further,” Hummel and colleagues wrote.

In a related editorial, Linda van Horn, PhD, RDN, and Mark D. Huffman, MD, MPH, from the department of preventive medicine at the Feinberg School of Medicine, Northwestern University, wrote: “Although the GOURMET-HF pilot trial may have been underpowered to demonstrate differences in key outcomes, if they do exist, the signal on rehospitalization is promising.”

Van Horn and Huffman also noted that further research is warranted.

Diet interventions for malnourished patients with HF may be a safe and ultimately cost-effective strategy to improve both the quality of life and the quality of meals of these patients,” van Horn and Huffman wrote. – by Melissa J. Webb

Disclosures: The study was funded by the NIH/National Institute of Aging and PurFoods, LLC. Hummel and colleagues no relevant financial disclosures. Huffman reports he has received support from the American Heart Association, AstraZeneca, Verily and the World Heart Federation’s Emerging Leaders program, which is supported by Boehringer Ingelheim and Novartis. Van Horn reports no relevant financial disclosures.