University of Michigan Frankel Cardiovascular Center, Ann Arbor (S.L.H., B.W.G., J.W., C.M., M.C.).
Ann Arbor Veterans Affairs Health System, MI (S.L.H., E.T.).
Circ Heart Fail. 2018 Aug;11(8):e004886. doi: 10.1161/CIRCHEARTFAILURE.117.004886.
Background In patients with heart failure (HF), malnutrition and dietary sodium excess are common and may worsen outcomes. No prior studies have provided low-sodium, nutritionally complete meals following HF hospitalization. Methods and Results The GOURMET-HF study (Geriatric Out-of-Hospital Randomized Meal Trial in Heart Failure) randomized patients discharged from HF hospitalization to 4 weeks of home-delivered sodium-restricted Dietary Approaches to Stop Hypertension meals (DASH/SRD; 1500 mg sodium/d) versus usual care. 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. Conclusions Home-delivered DASH/SRD after HF hospitalization appeared safe in selected patients and had directionally favorable effects on HF clinical status and 30-day readmissions. Larger studies are warranted to clarify the effects of postdischarge nutritional support in patients with HF. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02148679.
背景：在心力衰竭（HF）患者中，营养不良和饮食中钠过量很常见，并且可能会使预后恶化。之前尚无研究提供 HF 住院后低钠、营养全面的膳食。
方法和结果：GOURMET-HF 研究（老年心力衰竭院外随机膳食试验）将从 HF 住院出院的患者随机分为 4 周家庭送餐的限制钠的 DASH（限钠饮食防治高血压）膳食（DASH/SRD；1500mg 钠/天）与常规护理组。主要结局是从出院到出院后 4 周时，两组间堪萨斯城心肌病问卷综合评分的变化。其他结局包括堪萨斯城心肌病问卷临床综合评分和心脏生物标志物的变化。所有患者在 12 周时均进行死亡/全因再入院和潜在饮食相关不良事件（症状性低血压、高钾血症、急性肾损伤）的随访。66 名患者在出院时按 1:1 随机分为 DASH/SRD 与常规护理组（年龄 71±8 岁；30%为女性；射血分数 39±18%）。两组间堪萨斯城心肌病问卷综合评分的增加相似（DASH/SRD 组 46±23-59±20 与常规护理组 43±19-53±24；P=0.38），但 DASH/SRD 组患者的堪萨斯城心肌病问卷临床综合评分增加趋势更大（47±22-65±19 与 45±20-55±26；P=0.053）。潜在的饮食相关不良事件并不常见；DASH/SRD 组患者在 30 天 HF 再入院率（11%比 27%；P=0.06）和该时间段内再住院天数（17 天比 55 天；P=0.055）有下降趋势。
结论：在选定的患者中，HF 住院后家庭送餐的 DASH/SRD 似乎是安全的，并且对 HF 临床状况和 30 天再入院率有有利的影响。需要更大规模的研究来明确 HF 患者出院后营养支持的效果。
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