Less Than 25% of Patients Receive Dietary Advice Post Heart Attack

Insideprecisionmedicine.com 6/3/24

A retrospective study conducted by researchers at the University of Michigan (U-M) Health Frankel Cardiovascular Center found that fewer than one-in-four patients who had experienced a major heart condition—such as heart attack or heart failure—received dietary counseling after the occurrence. The findings, published in the Journal of the Academy of Nutrition and Dietetics, tracked 150,000 patients seen at hospitals in Michigan between late 2015 and early 2020, revealed this major gap in cardiac care despite data showing that diet is a leading cause of premature death from heart disease.

“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,” said senior study author Brahmajee Nallamothu, MD, a professor of internal medicine-cardiology at U-M Medical School.

The findings are even more stark based on the level of care patients receive after hospitalization for a cardiac event. While 23% of all cases received some form or dietary counseling within 90 days of hospitalization, most of the dietary counseling documentation was within cardiac rehab, a program that is considered underutilized as only 20–30% of eligible patients participate. Removing the counseling received in this setting, the research showed that clinicians offered dietary counseling only five percent of the time.

The investigators believe there are a couple of different factors contributing to this very low rate: a lack of time for clinicians to provide the counseling and clinicians lacking expertise in this form of health advice.

“When patients receive this education, we have seen tremendous results—some have cut cholesterol levels in half within weeks,” said first author Eric Brandt, MD, director of preventive cardiology at the Frankel Cardiovascular Center.

Among the populations least likely to receive dietary counseling were women, people over the age of 65, and patients with chronic kidney disease. Further, patients with private insurance were more likely to receive dietary advice. Traditional Medicare recipients were less likely than those with private insurance to receive the counseling and people with Medicaid were the least likely to receive it.

Prior research indicates that about half of all people in the U.S. have a poor-quality diet, and that many struggle to afford healthier foods. Understanding the effect poor diet can have on population health, in 2022 the American Heart Association released a position statement supporting all efforts to “increase equitable access to nutritious, affordable food” into health care delivery.

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