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Introduction: In patients with heart failure (HF), malnutrition and excess dietary sodium intake
are common and may worsen outcomes. However, some studies suggest no benefit or even
harm related to dietary sodium restriction in HF. No previous studies have examined
the effects of providing low-sodium, nutritionally-complete meals following discharge
from HF hospitalization. Hypothesis and Outcomes: Compared with usual care, home meal delivery of the sodium-restricted Dietary Approaches
to Stop Hypertension (DASH/SRD) eating pattern will improve HF-related quality of
life at 4 weeks post-discharge from HF hospitalization. In addition to safety monitoring
and clinical event reporting, additional data collected in the study include changes
in cardiac and inflammatory biomarkers, cardiac and vascular function, micronutrient
levels, and salt taste affinity. Methods: GOURMET-HF is a three-site, single-blind, randomized controlled pilot trial (NCT02148679)
in patients admitted for acutely decompensated HF with previous history of hypertension.
Participants were randomized at hospital discharge to home-delivered DASH/SRD (1500 mg
sodium/day) vs. usual care. The primary study outcome is the between-group change
in the Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score from baseline
to 4 weeks post-discharge. The main exclusion criteria were symptomatic hypotension,
hyperkalemia, and severe renal insufficiency (estimated glomerular filtration rate
[eGFR] < 30 ml/min/1.73 m2). Key clinical outcomes include death/all-cause readmission
and potential diet-related adverse events (symptomatic hypotension, hyperkalemia,
acute kidney injury). Additional outcomes include change in KCCQ sub-domains, including
the Clinical Summary Score (average of Physical Limitation and Total Symptom scores),
and general quality of life (SF-12, Visual Analog Scale). Paired t-testing was used
for within-group and ANCOVA, 2-sample t-testing, chi-square, or Fisher's exact test
were used as appropriate for between-group comparisons. Results: Of 107 enrolled participants, 66 met criteria at hospital discharge and were randomized
1:1 to DASH/SRD vs. usual care (age 71 ± 8 years, 30% female, 30% African-American,
36% Hispanic, 56% diabetes mellitus, body mass index 32.6 ± 7.7 kg/m2, ejection fraction
39 ± 18%, eGFR 54 ± 17). The HF-related quality of life increased in both groups at
4 weeks; general quality of life did not change. The change in KCCQ Summary Score
did not differ between groups, but KCCQ Clinical Summary Score improved to a greater
degree in the DASH/SRD group (Figure). Potentially diet-related adverse events were numerically more common, but 30-day
readmissions and days hospitalized trended lower in the DASH/SRD group (Table). Conclusions: Home-delivered DASH/SRD immediately following HF hospitalization appeared safe in
selected patients, and had directionally favorable effects on HF clinical status and
30-day readmissions. Larger studies are warranted to determine the effects of post-discharge
dietary support on functional status and readmission rate in patients with HF.
