Abstract P218: Dietary Prescription in the Coronary Care Unit, Missed Opportunity to Improve Care?

Abstract

Introduction: A notable portion of the excess burden of cardiovascular disease [CVD] risk factors in African Americans [AA] is believed secondary to the diet. Hypothesis: Dietary assessment and prescribed diets are inadequate in patients admitted to the coronary care unit [CCU]. Results: Cohort: 267 consecutively patients, AA 83%, male 55%, mean age 65 yrs, were assessed for cardiovascular [CV] risk factors, clinical status and appropriateness of prescribed diets. Patients were at increased CV risk as evidenced by 65% older than 60 yrs, Body Mass Index (BMI) >30 in 40% with women almost twice as likely to be obese [p<0.006], history of smoking 55%, hypertension 90%, diabetes 54%, and mean ejection fraction 43%. Established CAD acknowledged in 60%. Breakdown of diet orders: normal diet 11%, diabetic diet 38% and a form of low sodium, low cholesterol diet in 51%. CCU length of stay: 2.5 days with no significant difference by sex, diabetic or obesity status. Dietary assessment documentation was missing in 40% of the CCU admissions. A significant percentage of the patients missing this documentation were women [45%], diabetics [47%], obese--BMI>30 [42%] and older--age >60 [68%]. Incongruence is seen between the disease burden and the appropriate dietary order. For example, 54% of patients had DM. However, only 38% were given a diabetic diet. A form of low Na diet was provided to 51% of the patients yet 90% of them were hypertensive or had a history of hypertension. The statistic, dietary assessment not recorded in 40% of the patients, may have been affected by the relatively short CCU stay. One limitation of our study is that we did not examine if this decreased dietary assessment rate was affected by week-day vs. weekend stay in the CCU or by the severity of the patient’s illness. Conclusion: Dietary assessment and appropriate dietary prescription matters. Recent studies show that dietary pattern is one of the largest mediating factors for differences in the incidence of CV risks, i.e. hypertension, in blacks vs. whites accounting for some of the excess risk among blacks. Not adequately addressing nutrition in a CCU setting leads to the loss of a critical teachable moment.