Does DASH Diet Meal Delivery Help Heart Failure Outcomes?

Would heart failure patients have better outcomes if a doctor-recommended diet were delivered right to their door?

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A new publication finds that home meal delivery after discharge from the hospital appears safe, with positive but not statistically significant effects on several measures, including readmissions.

Michigan Medicine heart failure cardiologist Scott Hummel, M.D., M.S., first presented his primary results as a late-breaking clinical trial at the Heart Failure Society of America annual meeting in Dallas in 2017. The research has now been published in Circulation: Heart Failure.

"We already know heart failure patients are often not getting all the nutrients they need and are consuming more sodium than recommended," says Hummel, an assistant professor of internal medicine. "This is the first randomized clinical trial to test home-delivered, nutritionally complete, low-sodium meals after hospital discharge for acute decompensated heart failure."

Hummel's pilot trial, called GOURMET-HF, randomized 66 elderly subjects with heart failure to either usual care or meal delivery after they left the hospital. After 30 days, both groups of patients reported some improvements in their heart failure-related quality of life.

Hummel says that wasn't surprising, because a patient will begin to feel better after returning home from the hospital. But the group receiving meals had greater improvement in a questionnaire measure of heart failure symptoms and physical limitations.

There were 11 heart failure readmissions in nine patients in the 30-day period among patients receiving usual care, compared with three among patients receiving the DASH diet deliveries. After 84 days, the usual care group had 22 readmissions while the meal-delivery group had 13. There were no major differences in other adverse events among the two groups.

"While not statistically significant in this small study, these findings suggest that nutritional support has the potential to improve functional limitations and reduce heart failure readmissions," says Hummel, who focuses his research on diet's impact on heart failure, including the course of the disease and quality of life. "There's reason to further investigate."

Restricting sodium

Discrepancies in existing research about restricting sodium make this project important, Hummel says.

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"Heart failure dietary guidelines have been focused on restricting dietary sodium," Hummel says. "That's what we recommend to outpatients, and inpatients typically follow this restriction while in the hospital. However, a handful of research papers that questioned the safety of low-sodium diets made this an unanswered question for us."

Hummel says it can also just be difficult for a patient trying to adhere to strict dietary recommendations. Nationwide, he says, the correlation between salt and calories is high. That means a patient told to eat a low-sodium diet may just eat less. Since malnutrition is a major risk factor for poor outcomes in heart failure, good intentions could lead to bad results.

"Instead of giving people recommendations and hoping they would follow them, we thought we'd just provide them with the food," says senior author Mathew S. Maurer, M.D., of Columbia University Medical Center and New York-Presbyterian Hospital. "It may be difficult for older adults with mobility limitations to follow their doctors' recommendations if they can't regularly access a grocery store for healthy food."

For the delivery group, the research team adapted a meal plan from Purfoods, LLC's Mom's Meals NourishCare brand, which delivers nutritionally tailored, ready-made meals. The entrees followed the low-sodium DASH diet, which is recommended for patients with hypertension. The meals, provided by the company for the study, were refrigerated and prepared using simple microwave heating instructions.

Next steps

Hummel's team will continue to analyze the data gathered from this pilot trial, including measures of patient adherence and of salt taste affinity, which assesses whether a subject's taste for salt changes after eating a low-sodium diet.

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The team says more research is needed, including a larger clinical trial to determine whether nutritional support can reduce hospital readmissions in patients with heart failure.

Maurer says it will be important to continue studying signals of biological processes. "We need to know: Are we changing the salt taste sensitivity, reducing arterial or ventricular stiffness, decreasing inflammation, and/or generally nourishing these patients better?"

Hummel says, "There's more work to do to determine whether giving patients this nutritional support during a vulnerable period may help them in the long term, but these primary results show reason to keep investigating."

The National Institute on Aging, part of the National Institutes of Health, supported this research under award No. R21AG047939. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

This article was originally published on September 19, 2017, and was updated on August 10, 2018.