Innovation at ACC | ACC’s Hospital Food Initiative: Don’t Leave a Critical Component of Heart Health on the Table

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Consider this common scenario: your patient admitted three days ago with an acute myocardial infarction is doing well under your care. The emergent PCI went smoothly and a beta-blocker, ACE inhibitor, statin and dual antiplatelet agents are on board. Your patient has experienced no complications and discharge is anticipated soon.

But despite this seemingly flawless course, it might surprise you to learn there could still be one critical element of your patient’s hospital care that threatens to sabotage a successful long-term outcome. It involves potent oral agents administered TID to your patients – their hospital food.

Action Items for ACC’s Hospital Food Initiative

Take some time to learn more about the food served to patients in your hospital. Review the menus – including the ones for the “cardiac diet.” If you identify opportunities for improvement, consider scheduling a meeting with your hospital food services director, nutrition/dietetics team and cardiology nursing staff. Send them to ACC.org for more information.

Talk to your patients early during their hospital stay about the importance of a heart healthy diet. The dietitian can provide more detailed instruction, but your patients will be more strongly motivated to consider healthier food choices if they know that you consider nutrition to be a priority.

Make sure that your patient’s hospital diet is as carefully designed as the expert pharmacologic care you deliver. We owe it to our patients not to leave any opportunities for optimal health on the table – or tray.

Many of us may not be aware of the food served to our patients, including the meals that emerge from your well-intentioned order for a “cardiac diet.” In some hospitals, the differential diagnosis for dinner might very well include fried chicken, hot dogs, doughnuts and cola. Such choices are often provided by food services to please recovering patients with “comfort food”– partially in the quest for high patient satisfaction ratings.

An elegant study led by Robert A. Vogel, MD, FACC, 20 years ago proved that a single unhealthy meal can acutely impair endothelial function.1 Probably not the best plan for our patient post myocardial infarction. And long-term, the evidence in support of nutrition for cardiac protection is incontrovertible. The Lyon Diet Heart Study showed a striking 72 percent reduction in major cardiovascular events over nearly five years for those on a Mediterranean-style diet compared with controls.2 And a randomized controlled study, the Lifestyle Heart Trial, including a low-fat vegetarian diet paired with a program of stress management and physical activity, has demonstrated a regression of coronary artery disease.3

Hospitalization for any reason – but particularly for cardiac disease – presents an ideal opportunity as a “teachable moment” for the patient. During recovery from a cardiac event, patients are typically highly attuned to the fragility of good health and energized to consider positive lifestyle changes. What better time than during the hospital stay to introduce foods that could promote, rather than detract from, long-term heart health?

"Many of us may not be aware of the food served to our patients, including the meals that emerge from your well-intentioned order for a “cardiac diet."

Enter the Hospital Food Initiative developed by the Nutrition Working Group of the ACC’s Prevention Council. This program is intended to provide suggestions for healthy patient food options. Among the recommendations are to include, at least as an option, appealing meals that conform to the principles of the two diets with solid evidence for cardioprotection: a plant-based, low-fat, whole food diet and a Mediterranean-style diet. Specific recommendations include meal offerings that feature plentiful servings of vegetables and fruit; minimal added sugar; reduced salt; predominant use of whole grains over refined grains; complete avoidance of trans-fats; and no processed meats or sugar-sweetened beverages.

Despite the acknowledged nutrition controversies that often dominate scientific journals and the lay press, the limited recommendations in this initiative are strongly evidence-based and are broadly recognized to be health promoting.


Stephen Devries, MD, FACC is executive director of the nonprofit Gaples Institute for Integrative Cardiology in Deerfield, IL, and associate professor at Northwestern University Feinberg School of Medicine in Chicago, IL. Neal D. Barnard, MD, FACC is adjunct associate professor of medicine at George Washington University School of Medicine and president of the Physicians Committee for Responsible Medicine in Washington, DC. Andrew M. Freeman, MD, FACC is co-chair of ACC’s Nutrition and Lifestyle Work Group and director of Cardiovascular Disease Prevention and Wellness at National Jewish Health in Denver, CO.

References

  1. Vogel RA, Corretti MC, Plotnick GD, et al. Am J Cardiol 1997;79:350-4.
  2. de Lorgeril M, Salen P, Martin JL, et al. Circulation 1999;99:779-85.
  3. Ornish D, Scherwitz LW, Billings JH, et al. JAMA 1998;280:2001-7.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Atherosclerotic Disease (CAD/PAD), Nonstatins, Novel Agents, Statins, Diet, Exercise

Keywords: ACC Publications, Cardiology Magazine, Food Service, Hospital, Vegetables, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Platelet Aggregation Inhibitors, Coronary Artery Disease, Nutritionists, Diet, Length of Stay, Sweetening Agents, Patient Satisfaction, Diagnosis, Differential, Dietetics, Fruit, Meals, Food Preferences, Diet, Beverages, Myocardial Infarction, Exercise, Angiotensin-Converting Enzyme Inhibitors, Nursing Staff, Diet, Vegetarian


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