Etiological Role of Diet in 30-Day Readmissions for Heart Failure: Implications for Reducing Heart Failure-Associated Costs via Culinary Medicine

Abstract

Background. Reducing the under-30-day readmission for heart failure (HF) patients is a modifiable quality-of-care measure, yet the role of diet in HF readmissions and cost-effective HF care remain ill-defined. Methods. Medical chart review was conducted to determine cause(s) for HF treatment failure. Randomized controlled trial-backed machine learning models were employed to assess the relationship of culinary medicine education with HF 30-day readmission rate and cost. Results. Of 1031 HF admissions, 130 occurred within 30 days of discharge (12.61%.) Nearly two-thirds of individuals were male (64.02%), while the mean age and median length of stay were 64.33 ± 14.02 and 2, respectively. Medication noncompliance (34.62%) was the most common etiology for 30-day readmissions, followed by dietary noncompliance (16.92%), comorbidity (16.92%), a combination of dietary and medication noncompliance (10%), HF exacerbation (10%), iatrogenic (10%), and drug abuse (1.54%). Medication noncompliance contributed to the highest gross charge by readmission, costing a total of $1 802 096. Compared with traditional care, culinary medicine education for HF patients would prevent 93 HF readmissions and save $3.9 million in an estimated 4-year period. Conclusion. Though pharmacological treatment remains a focal point of HF management, diet-based approaches may improve tertiary HF prevention and reduce HF-associated health care expenditures.

Keywords: cooking; heart failure; lifestyle; nutrition therapy; patient readmission.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© 2019 The Author(s).

Figures

Figure 1.

Graphical analysis of underlying etiology of a 30-day readmission for heart failure (HF) as the primary diagnosis at an academic medical center in the Southeastern United States for the 2012-2015 time period.

Figure 2.

Clinical and cost savings of HF hospitalizations associated with culinary medicine education developed through randomized controlled trial–backed machine learning analysis. Abbreviations: CHOP, Cooking for Health Optimization with Patients; HF, heart failure; Med., medication; PREDIMED, Primary Prevention of Cardiovascular Diseases with a Mediterranean Diet; RCT, randomized controlled trial.