Dietary counseling lacking in treatment for heart patients

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Dietary counseling frequently is left out of continuing treatment for patients who undergo heart attacks or heart failure, according to a new study.

It has become established that diet is a major factor in heart disease. But new research tracking 150,000 patients showed from 2015 to 2020, clinicians documented they offered dietary counseling in 23% of cases, within 90 days of hospitalization.

“Nutrition counseling may reduce the risk a person has for cardiovascular episodes and disease, yet our research shows that the vast majority of patients, who are all at risk after significant heart events, are not receiving this essential education,” senior author Brahmajee Nallamothu, MD, MPH, said in a news release. Nallamothu is a professor of internal medicine-cardiology at U-M Medical School.

Much of the dietary took place within cardiac rehabilitation – which itself is underused, with approximately 20% to 30% of patients participating, according to the research from the University of Michigan (U-M) Health Frankel Cardiovascular Center. Not counting cardiac rehab, the figure for clinicians offering dietary counseling patients dropped to 5%, according to the study, “Dietary Counseling Documentation Among Patients Recently Hospitalized for Cardiovascular Disease,” published in Journal of the Academy of Nutrition and Dietetics.

Who receives counseling?

Patients less likely to receive counseling included women, adults over 65 years old and patients with chronic kidney disease. The researchers suggested payment could be a factor. Medicare will cover medical nutrition therapy (MNT) for Medicare patients living with diabetes and end stage kidney disease, so those patients were more likely to receive dietary counseling than patients on Medicaid. Traditional Medicare patients were less likely to get food counseling than those with private insurance, according to the news release.

“In my long history as a registered dietitian nutritionist, I have felt so grateful seeing how many patients benefit from medical nutrition therapy, yet my patients and I are equally saddened to see that the majority of people must pay out of pocket or be turned away because of lack of access to MNT services by Medicare,” Geeta Sikand, MA, RDN, FAND, said in the news release. Sikand is a registered dietitian nutritionist and an associate clinical professor of medicine in the cardiology division at University of California, Irvine.

Time, knowledge, lifestyle

Along with reimbursement, the researchers said lack of time and knowledge may be reasons why physicians and other clinicians don’t discuss healthy food options with patients, even though the effects can be “tremendous.”

Meanwhile, many patients struggle to afford healthy foods. The researchers cited the American Heart Association’s 2022 position paper calling for increasing equitable access to nutritious, affordable food in health care delivery.

“Lifestyle is the cornerstone for preventing cardiovascular disease,” Eric Brandt, MD, MHS, FACC, said in the news release.

“Without providing counseling on changing behaviors to choose the foods that our patients should eat, many are left without the tools to manage nutrition,” he said. “I hope to see the landscape change where eating healthier is more well supported and achievable.”