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CMHC PULSE

Cardio Metabolic Health Congress – Official Blog

Caloric Deficiencies Increase Risk of HF Hospitalization

Heart failure (HF) remains a deadly disease tied to a high risk of hospitalizations, reduced cardiorespiratory fitness and a subsequently reduced quality of life. Targeted treatments and lifestyle interventions continue to show promising results in improving HF outcomes although, there is limited evidence of their role in decompensated patients admitted to the hospital for acute heart failure.

The most common non-pharmacologic therapy for HF patients is dietary sodium restriction, aimed at mitigating excess fluid retention. However, this method is supported by limited and controversial evidence as some studies have shown sodium restriction can even worsen health outcomes by leading to unintended reductions in calorie, macro-, and micro-nutrient intake. Additionally, the effects of sodium restriction as an intervention on quality of life and clinical outcomes remain unknown.

As patients with heart failure commonly present with poor nutritional status – which significantly affects disease progression and prognosis – new research from the University of Michigan in Ann Arbor aims to uncover the clinical implications of dietary patterns on HF. Published in JACC: Heart Failure, the GOURMET-HF trial found that heart failure patients who had an insufficient calorie intake faced an increased risk of hospital readmission  and a poor quality of life after being discharged.

Hospitalizations in HF Patients

Led by Feriha Bilgen, MPH, RD, a group of researchers analyzed data gathered from 57 patients – mean age of 70 years, 31% women, mean BMI 32 kg/m2 – hospitalized for decompensated heart failure. To assess nutritional intake, participants completed the Block Food Frequency Questionnaire at baseline and serum albumin and body weight were then used to calculate Nutritional Risk Index. Insufficient calorie intake was defined as meeting less than 90% of estimated nutritional needs; a 15-point deficiency score was developed taking into account the intake of certain micronutrients – such as folate, magnesium, iron, and calcium.

The primary measured outcomes of the study included all-cause hospital readmission and change in Kansas City Cardiomyopathy Questionnaire clinical summary score, which was assessed 12 weeks after hospital discharge.

Importance of Nutritional Patterns

Overall, the median sodium intake of patients in the trial was 2,987 mg per day and the median calorie intake was 1,602 kcal/day. Only 11% were considered malnourished according to the Nutritional Risk Index equation.

Researchers found that patients who consumed less than 2,000 mg of sodium per day – the standard recommendation in heart failure patients – often consumed an insufficient amount of calories overall and had protein and micronutrient deficiencies as well.

At the 12-week point, participants who had insufficient calorie intake were more likely to be readmitted to the hospital and showed less improvement in the Kansas City Cardiomyopathy Questionnaire clinical summary score. These patients were readmitted to the hospital for longer than those who had a sufficient calorie intake during the study.

Implications

The latest findings suggest that sodium restriction may not have favorable results in patients with HF. Instead, experts recommend lifestyle interventions aimed at increasing unsaturated fatty acids intake or improving adherence to the DASH diet for patients with chronic and stable HF.

“Of note, both the Mediterranean diet and DASH diet are primarily composed of plant-based foods, suggesting that a prudent plant-based dietary pattern might be beneficial in HF,” Kathleen E. Allen, MS, RD of Dartmouth College Geisel School of Medicine wrote in an accompanying editorial to highlight potential benefits of certain diets.

“The main message of this paper is that patients who are eating low-sodium diets may also have deficiencies in other important dietary components like micronutrients that help with mitochondrial function and protein for building muscle,” Scott L. Hummel, MD, MS, section chief of cardiology at VA Ann Arbor told Healio in an interview.

Researchers hope that the results of their findings raise awareness of the potential adverse consequences of sodium restriction and emphasize the need for lifestyle interventions to be introduced under the supervision of a dietitian. Physicians must exercise caution to help maintain overall nutrition while reducing sodium intake to reduce potential consequences of dietary deficiencies in patients hospitalized with HF.

 

What to Expect at the CMHC West Live Online Event

Our online, interactive learning event, CMHC West Live Online: Complexities in Cardiometabolic Care, connects healthcare practitioners to eminent education in the field of cardiometabolic health from the setting of their choosing. Live-streamed sessions focused on the unique challenges experienced by cardiometabolic practitioners will provide actionable and practical tools to help clinicians navigate the current practice landscape; they will also provide opportunities for participants to ask questions and hear direct responses from faculty members throughout the conference. CMHC West Live attendees can expect to engage with the latest clinical evidence and obtain a comprehensive education delivered in an interactive and easy-to-navigate format by prominent leaders in cardiometabolic health.

Curated by a faculty panel of world-renowned experts in the field, this conference will spotlight the latest clinical education providing a holistic and expert understanding of a variety of topics ranging from obesity and diabetes management to kidney disease and hypertension. The final day of our online event will be dedicated to an interactive specialty summit exploring participant-submitted case studies highlighting advanced approaches for challenging patient cases. CMHC Live Online will provide the opportunity to join world-renowned experts in an investigative deep dive of the latest advances in cardiometabolic knowledge.

What Clinicians Can Expect 

Attendees of the CMHC West Live event can expect to receive the most clinically current, relevant, and applicable knowledge in the field of cardiometabolic health while learning targeted strategies aimed at combating the growing epidemic of cardiovascular disease and its many risk factors.

Access the Latest Clinical Education

The three-day event will feature the latest and most comprehensive clinical education in cardiometabolic medicine, giving attendees the opportunity to engage with the most cutting-edge techniques and up-to-date data: including content focused on obesity and lifestyle medicine, kidney disease, hypertension, and diabetes management as well as standards of cardiometabolic care.

Furthermore, attendees will be introduced to the fusion of cultural heritage and cardiometabolic health via sessions spotlighting the most recent results from clinical trials specifically exploring aspects related to indigenous communities through thought-provoking and innovative education.  

Hear From World-Renowned Faculty, Clinicians, & Speakers

Each session at CMHC West Live has been carefully designed and planned by our expert panel of the most respected and renowned leaders in the cardiometabolic field. Leading CMHC Chairpersons include George L. Bakris, MD, Christie M. Ballantyne, MD, Robert H. Eckel, MD, and Anne L. Peters, MD. 

George L. Bakris, MD 

Dr. Bakris is a distinguished Professor of Medicine and Director at the ASH Comprehensive Hypertension Center at the University of Chicago. Having published over 700 articles and book chapters investigating kidney disease, hypertension, and nephropathy progression, Dr. Bakris is an expert in the field. He has served on many national committees, including the American Diabetes Association Clinical Practice Guideline committee, and currently serves as a special government expert to the Cardio-renal Advisory Board of the FDA and CMS as well as an editorial board member of 16 renowned scientific publications.

Christie M. Ballantyne, MD  

Professor of Medicine and Chief of Cardiovascular Research and Cardiology at the Baylor College of Medicine, Dr. Ballantyne is one of the most prominent experts in the field of lipids, atherosclerosis, and heart disease prevention. Dr. Ballantyne’s research efforts in prevention techniques led him to become an established investigator for the American Heart Association. He has been elected as Fellow of the American Association for the Advancement of Science, the American Society of Clinical Investigation, and the Association of American Physicians and has been recognized as one of “The World’s Most Influential Scientific Minds” by Thomson Reuters.

Robert H. Eckel, MD 

Dr. Eckel, a Charles A Boettcher II Endowed Chair in Atherosclerosis, is the retired Professor of Medicine in the Division of Endocrinology, Metabolism, Diabetes and Cardiology, at the University of Colorado. He currently serves as the Director of the Lipid Clinic at the University of Colorado Hospital and Program Director of the National Center for Research Resources Discovery Translation. His research efforts have focused on the pathogenesis and treatment of lipid disorders, obesity, metabolic syndrome, as well as diabetes; Dr. Eckel’s research is targeted at uncovering basic mechanisms of how metabolic diseases relate to cardiovascular and pulmonary disease to gather data that will lead to more favorable diagnostics and therapeutic options.

Anne L. Peters, MD 

Keck School of Medicine professor at the University of Southern California, Dr. Peters also serves as the Director of Clinical Diabetes Programs and has been a principal investigator on multiple prominent clinical trials focused on diabetes and diabetes prevention. Dr. Peters has published several books on diabetes and over 100 scientific articles in peer-reviewed medical journals such as JAMA, the New England Journal of Medicine, and Diabetes Care. Currently, she serves on the ABIM Endocrine Board, multiple ADA committees, and EASD/ADA Diabetes Technology Committee.

The Latest Clinical Topics

At CMHC West Live, our panel of world-renowned cardiometabolic experts will spotlight the latest and most clinically relevant education in an extensive range of topics from disease management strategies to novel therapeutic methods aimed at improving patient outcomes.

The full agenda for the virtual event can be accessed here.

Obesity and Lifestyle Medicine 

The initial Obesity and Lifestyle Medicine Session on Friday August 7, 2020 will be chaired by Robert H. Eckel, MD and will spotlight disease management techniques among many other topics. Experts will discuss practical approaches to exercise and lifestyle interventions, the challenges and advances in obesity pharmacotherapy, the NAFLD and NASH spectrum, and will cover prominent nutritional controversies in the field of cardiometabolic health. 

Diabetes Management 

 As the second session of the day, Diabetes Management will delve into clinical updates in diabetes management and disease progression. Chaired by Anne L. Peters, MD, the session will explore the intricacies of metabolic surgery and its role in diabetes remission, strategies for delaying the progression of prediabetes to diabetes and implications for frontline clinicians, as well as updates for intensive glucose control. Experts will also delve into type 2 diabetes management in children and young adults as well as the challenges of T2D management when cost and accessibility are an issue.

Kidney Disease, Heart Failure, Hypertension 

Chaired by George L. Bakris, MD, the Kidney Disease, Heart Failure, and Hypertension session will take place on Saturday August 8, 2020 and will explore the latest clinical data in the diagnosis and management of resistant hypertension including challenging cases and issues. Experts will address advances in prevention of and treatment of heart failure and novel methods of improving renal outcomes. Panel discussions and Q&A sessions will further explore approaches to elevating the standard of care.

Dyslipidemia, Atherosclerosis, Thrombosis 

The second session of the day – Dyslipidemia, Atherosclerosis, and Thrombosis – will be chaired by Christie M. Ballantyne, MD. Topics discussed will include strategies for personalized lipid therapy, updates on antiplatelet and antithrombotic therapies, as well as statin drug interactions in cardiovascular patients. Further, experts will also present updates in secondary ASCVD prevention as well as opportunities for improved prevention and treatment in individuals of South Asian descent.

Complexities in Cardiometabolic Care Summit

The final day of the CMHC West Live event will center around the unique challenges faced by clinicians in the management of patients with cardiometabolic disease. Led by the four CMHC Chairpersons, the one-day summit will address the future of cardiometabolic medicine as a specialty outlining diagnostic, prevention, and clinical decision-making methods to optimize patient outcomes. Tackling the complexity of cardiometabolic care, our expert panel will present challenging patient cases submitted by attendees and explore optimal management solutions.

 

Clinicians interested in gaining an expert and comprehensive understanding of the latest clinical pearls, advancements, and approaches to cardiometabolic medicine are invited to join other world-renowned practitioners, researchers, and educators at the interactive, virtual CMHC West Live Online event. It’s not too late to register for our innovative conference, sign up here to attend.