Fewer than a quarter of heart attack patients receive dietary advice afterward

Diet is the leading cause of premature death from heart disease in the United States, yet less than a quarter of people who suffer a major heart attack receive dietary counseling afterwards, a study has found.

The study, led by a team at the University of Michigan Frankel Heart and Vascular Center, followed nearly 150,000 patients who had serious heart problems, like heart attacks or heart failure, at hospitals across Michigan from late 2015 to early 2020.

The results were announced Journal of the Academy of Nutritiondocumented that in only 23% of cases, clinicians provided dietary counseling within 90 days of hospitalization.

This counseling may occur as part of a supervised cardiac rehabilitation program or as part of another type of care called medical nutrition therapy.

This approach involves detailed nutritional assessments and targeted interventions led by a registered dietitian.

“Nutrition counseling may reduce the risk of cardiovascular events and disease, but our research shows that the majority of patients at risk after a major heart attack are not receiving this important education.”

Brahmajee Nallamothu, MD, MPH, professor of medicine and cardiology in the U-M School of Medicine, and senior author

Most of the documentation on dietary counseling is in the context of cardiac rehabilitation, and the program itself is considered underutilized, with only approximately 20–30% of eligible patients participating.

Excluding cardiac rehabilitation, clinicians provided dietary counseling only 5% of the time.

The researchers suggest that the reason for this low rate may be a lack of time for clinicians to provide counseling and expertise in this area.

“When patients receive this education, we see amazing results – some have cut their cholesterol levels in half within a few weeks,” said first author Eric Brandt, MD, MPH, FACC, director of preventive cardiology at the Frankel Heart and Vascular Center.

“However, physicians are often limited by the time they need to manage other aspects of their patients’ medical conditions. Moreover, most cardiologists are not adequately educated to offer dietary advice themselves.”

Women, adults aged 65 years or older, and patients with chronic kidney disease were all less likely to receive counseling from their health care providers.

Those with traditional Medicare were less likely to receive dietary counseling than those with private insurance but more likely than those with Medicaid.

Currently, medical nutrition therapy is only available to Medicare patients with diabetes and end-stage renal disease.

“During my long career as a registered dietitian, I have been so grateful to see so many patients benefit from medical nutrition therapy, but it saddens both my patients and me alike to see the majority of people being turned away because they have to pay out of pocket or don’t have access to MNT services through Medicare,” says Geeta Sikand, MA, RDN, FAND, RD, clinical associate professor in the Department of Cardiology at the University of California, Irvine, and registered dietitian.

Nearly half of American adults have poor diet quality, yet many struggle to afford healthy foods. In 2022, the American Heart Association released a position statement supporting efforts to “increase equitable access to nutritious, affordable food” in health care delivery.

“Lifestyle is the cornerstone of preventing cardiovascular disease,” Brandt said.

“Without providing counselling to help patients change their food choices, many patients are left without the resources to manage their nutrition. Our hope is that healthy eating will be better supported and made achievable.”

Additional authors include Matthias Kirch, MS, John Z. Ayanian, MD, MPP, Tammy Chang, MD, MPH, MS, and Michael P. Thompson, Ph.D, of the University of Michigan.

This research was supported by the Blue Cross Blue Shield Foundation of Michigan.

Brandt reports research funding from the National Institutes of Health (K23MD017253) and the Blue Cross Blue Shield of Michigan Foundation.