CardioExchange Archive

I think we can all agree that counseling patients on diet is one of the least rewarding parts of being a doctor. Nobody likes telling adults what they can and cannot eat. And sometimes the recommendations seem so obvious that, to us, it borders on nagging.

Of course patients with hypertension and heart failure should avoid salt. 

Of course patients with heart disease should avoid high-fat food. 

Of course patients with diabetes should avoid sugar. 

But a recent study in the American Journal of Medicine caught my eye. Hummel and colleagues examined data from a multi-hospital collaborative effort to improve quality of inpatient care for heart failure patients. Their findings reinforce the need to not only address the “doctory” issues, such as therapeutic decisions, with patients but also to nag them about diet. 

When the researchers looked at the discharge counseling given to heart failure patients, they found that those with preserved systolic ejection fraction function (≥50%) were less likely than those with diminished function (<40%) to receive counsel on weight monitoring (33% vs. 43%) and sodium restriction (42% vs. 53%). Rates of following other ACC/AHA discharge recommendations — e.g., provide a medication list and a plan for worsening symptoms — were approximately the same in the two groups. Most interestingly, the heart failure patients with preserved systolic function who received discharge counseling on sodium-restricted diet had lower odds of 30-day death or readmission. No other discharge recommendations predicted 30-day outcomes.

To me, this was a reminder:
Of course patients with heart failure should avoid salt — but we have to remember to tell them, again and again.

So when you are rounding on your heart failure patients (and patients with hypertension, heart disease, diabetes, and so on) or seeing them in your office, do you make the five minutes to reinforce dietary restrictions and discuss what’s right and what’s wrong to eat? Do you distribute dietary handouts or ask the nurses to provide counseling instead?