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 that 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 PO agents administered TID to your patients—their hospital food.

Many of us may not be aware of the food served to our patients, including the meals that emerge from a 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 in order to please recovering patients with "comfort food"—partially in the quest for high patient satisfaction ratings.

An elegant study led by Dr. Robert Vogel 20 years ago proved that a single unhealthy meal can acutely impair endothelial function.¹ Probably not the best plan for our post-MI patient. And long-term, the evidence in support of nutrition for cardiac protection is incontrovertible. The Lyon Mediterranean Diet Study showed a striking 72% reduction in major cardiovascular events over nearly 5 years for those on a Mediterranean-style diet compared to controls.² And a randomized controlled study, the Lifestyle Heart Trial,³ including a low-fat vegetarian diet paired with a program of stress management and physical activity, has actually demonstrated a regression of coronary artery disease.

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?

Enter the Hospital Food Initiative, developed by the Nutrition Working Group of the American College of Cardiology Prevention Council. This program is intended to provide suggestions for healthy patient food options. The details can be found here, but the main points include recommendations 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, 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.

Action Items:

• Take some time to learn more about the food served to patients in your hospital. Review the menus, including 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, and share the ACC link to the Hospital Food Initiative.
• 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 the tray.

References

1. Vogel RA, Corretti MC, Plotnick GD. Effect of a single high-fat meal on endothelial function in healthy subjects. Am J Cardiol 1997;79:350-4.
2. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999;99:779-85.
3. Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998;280:2001-7.

Keywords: Food Service, Hospital, Coronary Artery Disease, Nutritionists, Patient Satisfaction, Food Preferences, Myocardial Infarction, Primary Prevention, Secondary Prevention

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