Effectiveness and Implementation of a DASH Diet Intervention for Outpatient Heart Failure Management: Preliminary Results of a Pragmatic Clinical Trial

Objectives: Emerging evidence suggests efficacy of the Dietary Approaches to Stop Hypertension (DASH) diet for heart failure (HF) management, but pragmatic studies exploring DASH diet effectiveness are needed. This study evaluates the effectiveness and implementation of an evidence-based DASH diet intervention for outpatient HF management. Methods: This pilot single-center prospective effectiveness-implementation hybrid type 1 pragmatic clinical trial used a one-group pretest-posttest study design. HF patients were recruited from a university medical center cardiology clinic. The 6-month DASH diet intervention consisted of four medical nutrition therapy visits. Demographics, vitals, and lab results were extracted from the electronic health record. Dietary data, diet self-efficacy, and quality of life were evaluated with 3-day food records and questionnaires. Preliminary clinical and questionnaire data were analyzed via t-tests. Patient exit interviews were qualitatively coded. The RE-AIM/PRISM framework was used for implementation evaluation. Results: Twenty-six adult (15 women) HF patients aged 34-85 y completed the DASH diet nutrition education intervention. Baseline blood pressure (BP) was 120.2±14.8/71.4±10.1 mm Hg and BMI was 33.4±10.1 kg/m2. There were no changes in BP, weight, C-reactive protein, N-terminal pro b-type natriuretic peptide, total cholesterol, or HDL. LDL decreased after the 6-month intervention (p< 0.014) and triglycerides decreased after the first 3 months (p< 0.020). Several quality of life and diet self-efficacy parameters improved. Patients reported changing eating habits and meeting goals after completing the study, and they perceived improvements to their quality of life. Evaluation identified contextual barriers and facilitators to implementation. Conclusions: Behavioral, clinical, and implementation strategies will enhance and advance nutrition evidence-based practice standards for outpatient heart failure management. Preliminary results indicate intervention acceptance, but further evaluation of dietary and laboratory data may better support DASH diet effectiveness and personalized precision nutrition in heart failure care. Funding Sources: American College of Cardiology Foundation; USDA Agricultural Experiment Station.