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Home-Delivered Meals Postdischarge From Heart Failure Hospitalization (GOURMET-HF)

An Evidence-Based Practice

Description

This is a 12 week, three center, randomized controlled trial created to determine the efficacy of home-delivered sodium-restricted Dietary Approaches to Stop Hypertension (DASH/SRD)-compliant meals in older adults, aged 65 years and older, following discharge from a hospital admission for acutely decompensated heart failure. Study subjects received either pre-prepared, home-delivered DASH/SRD-compliant meals or attention control for 4 weeks after hospital discharge. The three study sites will be Columbia University Medical Center, the Ann Arbor Veterans Affairs Health System, and the University of Michigan Health System. Investigators were blinded to group assignment, food diaries, and urinary electrolyte measurements until the completion of the study

Goal / Mission

The goals of GOURMET-HF are to assess the safety of the intervention, including effects on cardiac biomarkers and rehospitalization burden.

Impact

Home-delivered DASH/SRD after HF hospitalization appear safe in selected patients and had favorable effects on HF clinical status and 30-day readmissions. The GOURMET-HF pilot study suggests that postdischarge nutritional support has the potential to improve HF symptoms and reduce readmissions

Results / Accomplishments

The primary outcome was the between-group change in the Kansas City Cardiomyopathy Questionnaire summary score from discharge to 4 weeks postdischarge. Additional outcomes included changes in the Kansas City Cardiomyopathy Questionnaire clinical summary score and cardiac biomarkers. All patients were followed 12 weeks for death/all-cause readmission and potential diet-related adverse events (symptomatic hypotension, hyperkalemia, acute kidney injury). Sixty-six patients were randomized 1:1 at discharge to DASH/SRD versus usual care (age, 71±8 years; 30% female; ejection fraction, 39±18%). The Kansas City Cardiomyopathy Questionnaire summary score increased similarly between groups (DASH/SRD 46±23– 59±20 versus usual care 43±19–53±24; p=0.38), but the Kansas City Cardiomyopathy Questionnaire clinical summary score increase tended to be greater in DASH/SRD participants (47±22–65±19 versus 45±20–55±26; p=0.053). Potentially diet-related adverse events were uncommon; 30-day HF readmissions (11% versus 27%; p=0.06) and days rehospitalized within that timeframe (17 versus 55; p=0.055) trended lower in DASH/SRD participants.

About this Promising Practice

Organization(s)
University of Michigan
Primary Contact
Scott Hummel, MD, MS
CARDIOVASCULAR CENTER
Floor 3 Reception C
1500 E Medical Center Dr SPC 5856
Ann Arbor, MI 48109-5856
888-287-1082
https://www.uofmhealth.org/profile/969/scott-lowel...
Topics
Health / Heart Disease & Stroke
Health / Physical Activity
Health / Older Adults
Organization(s)
University of Michigan
Source
Circulation Heart Failure Journal
Date of publication
8/10/2018
Date of implementation
May 2014
Location
Columbia University Medical Center, the Ann Arbor Veterans Affairs Health System, and the University of Michigan Health System
For more details
https://www.ahajournals.org/doi/full/10.1161/CIRCH...
Target Audience
Adults, Women, Men, Older Adults

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An Evidence-Based Practice meets the following HCI criteria:

  1. The program description includes at a minimum: the sponsoring organization, program goals, program implementation steps, and outcomes that have demonstrated program success in achieving the program goal in one or more localities.
  2. The results from an evaluation of the program include quantitative measures showing improvement in the outcome(s) of interest after the implementation of the program (i.e. increase in smoking cessation, not just the delivery of a smoking cessation program). The outcome measure(s) is/are compared at relevant time periods before and after the intervention or program implementation. Alternatively, the evaluation study compares the outcome(s) between an intervention group and an appropriate control group.
  3. The study is of peer-review quality and presents numbers in a scientific manner; measurements of precision and reliability are included (e.g. confidence intervals, standard errors), results from statistical tests show a significant difference or change in the outcome measure(s), and relevant point estimates and p-values are presented. Note: if the results from an evaluation of a program are presented in a scientific manner and the outcome measure is improved compared to the baseline measurement or the control group but the difference is not statistically significant, the practice is classified as effective and not evidence-based.