{"id":1352,"date":"2009-11-20T09:05:00","date_gmt":"2009-11-20T14:05:00","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/remembering-to-hold-the-salt\/"},"modified":"2011-07-19T17:45:31","modified_gmt":"2011-07-19T21:45:31","slug":"remembering-to-hold-the-salt","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2009\/11\/20\/remembering-to-hold-the-salt\/","title":{"rendered":"Remembering to Hold the Salt"},"content":{"rendered":"

I think we can all agree that counseling patients on\u00a0diet is one of the least rewarding parts of being a doctor. Nobody likes telling adults what they can and cannot eat. And sometimes the recommendations\u00a0seem so obvious that, to us, it borders on nagging.<\/p>\n

Of course<\/em> patients with hypertension and heart failure should avoid salt. <\/p>\n

Of course<\/em> patients with heart disease should avoid high-fat food. <\/p>\n

Of course<\/em> patients with diabetes should avoid sugar.\u00a0<\/p>\n

But a recent study in the American Journal of Medicine <\/a>caught my eye. Hummel and colleagues examined data\u00a0from\u00a0a multi-hospital collaborative effort to improve quality of inpatient care for heart failure patients. Their findings reinforce the need to not only address the\u00a0\u201cdoctory\u201d issues, such as therapeutic decisions, with patients but also to nag them about\u00a0diet. <\/p>\n

When\u00a0the researchers\u00a0looked at the discharge counseling\u00a0given to\u00a0heart failure patients,\u00a0they found that those with preserved systolic\u00a0ejection fraction function (\u226550%) were less likely than those with\u00a0diminished function (<40%) to receive counsel on weight monitoring\u00a0(33% vs. 43%) and\u00a0sodium\u00a0restriction (42% vs. 53%).\u00a0Rates of following other ACC\/AHA discharge recommendations —\u00a0e.g.,\u00a0provide a\u00a0medication list and a plan for worsening symptoms —\u00a0were approximately\u00a0the same in the two groups. Most interestingly,\u00a0the heart failure patients with preserved systolic function who received discharge counseling on sodium-restricted diet had lower odds of 30-day death or readmission. No other discharge recommendations predicted 30-day outcomes.<\/p>\n

To me, this was a reminder:
\nOf course<\/em> patients with heart failure should avoid salt — but we have to remember to tell them, again and again<\/em>. <\/p>\n

So when you are rounding on your heart failure patients (and\u00a0patients with hypertension, heart disease, diabetes, and so on) or seeing them in your office, do you make the five minutes to reinforce dietary restrictions and\u00a0discuss\u00a0what\u2019s right and what\u2019s wrong to eat? Do you\u00a0distribute dietary handouts or ask the nurses to provide\u00a0counseling instead? <\/p>\n

<\/blockquote>\n","protected":false},"excerpt":{"rendered":"

I think we can all agree that counseling patients on\u00a0diet is one of the least rewarding parts of being a doctor. Nobody likes telling adults what they can and cannot eat. And sometimes the recommendations\u00a0seem so obvious that, to us, it borders on nagging. Of course patients with hypertension and heart failure should avoid salt. […]<\/p>\n","protected":false},"author":277,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,7],"tags":[],"class_list":["post-1352","post","type-post","status-publish","format-standard","hentry","category-general","category-prevention"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/1352","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/277"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=1352"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/1352\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=1352"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=1352"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=1352"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}