Medically tailored meals reduced admissions and ED visits in heart failure

Design

Pragmatic, open-label randomised clinical trial

Population

206 adults with heart failure and a recent admission or ED visit, rural Navajo Nation

Primary outcome

All-cause hospitalisation or ED visit within 90 days

Effect

40.6% vs 57.0%; RR 0.72 (95% CI 0.54–0.96)

MUTTON-HF was a pragmatic open-label trial at two Indian Health Service sites in rural Navajo Nation. It randomised 206 adults with heart failure (mean ejection fraction 48%) who had been admitted or attended the emergency department in the past year to eight weeks of culturally and medically tailored meals built on traditional Navajo foods, or to usual dietary advice.

Within 90 days, 40.6% of the meal group had an all-cause admission or ED visit against 57.0% of controls (RR 0.72, 95% CI 0.54–0.96). Most of the effect was fewer admissions (12.3% vs 26.0%), and heart failure admissions specifically fell from 13.0% to 3.8%. Quality of life, food security, financial strain, weight and blood pressure all moved in the right direction.

The setting is specific and the trial small and short, but the signal is consistent with earlier medically tailored meal work. The general lesson for a ward physician is that food insecurity is a readmission risk factor worth asking about before discharge, and that meals that fit the patient's culture are more likely to be eaten.

• Ask every heart failure patient before discharge whether they can reliably get enough food, and low-salt food.
• Record food insecurity as a readmission risk factor in the discharge summary.
• Tailor dietary advice to what the patient actually eats at home, not a generic low-sodium sheet.
• Involve a dietitian or social worker when food access is a problem; in India, link to local community or government nutrition schemes where they exist.
• Review early after discharge — most readmissions in this trial happened within 90 days.

Why it matters

It puts food access alongside drugs and follow-up as a lever on heart failure readmission.

Don't overread it

This was a small, open-label, 12-week trial in one Indigenous community; the effect size may not transfer elsewhere.

The statistics, in plain English

A relative risk of 0.72 means about 28% fewer patients had an admission or ED visit. The confidence interval (0.54–0.96) excludes 1.0 but its upper end is close to it, so the true effect could be modest. The heart failure admission difference (3.8% vs 13.0%) is striking but rests on small numbers.

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