The Role of the Dietitian in an Outpatient Heart Failure Center

Abstract

LEARNING OUTCOME: To identify a model for the role of a dietitian in an outpatient heart failure center and to identify outcome indicators appropriate for use with congestive heart failure outpatients. The establishment of outpatient heart failure centers is recognized as an essential step in decreasing the staggering cost of caring for the patient with congestive heart failure (CHF). These outpatient centers use a multi-disciplinary team approach to aggressively manage and educate patients with CHF. One heart failure center in Nebraska received outside funding for a two-year demonstration project which will: 1) define the role of the dietitian in the heart failure center through the development and testing of practice guidelines, and 2) examine nutrition and health outcomes associated with the use of a dietitian in an outpatient heart failure center. As a first step in this project, a needs assessment was completed. Ten major heart failure centers were surveyed in order to identify their use of a dietitian. The results of this survey indicate that: 1) dietitians are not active members of outpatient heart failure teams, 2) ongoing patient teaching on sodium and fluid is the responsibility of nurses, and 3) nutrition education materials were not specific to the CHF patient. Patients enrolled in the heart failure center completed surveys which indicated confusion in understanding the most basic nutrition principles (e.g. importance of sodium versus fat), and interviews with the center's team members provided background on typical patient questions and ideas for incorporating the dietitian into the team. At the completion of year one of the project, a dietitian has developed, implemented and is testing nutrition practice guidelines based on the needs of heart failure staff and patients. Ninety percent of all heart failure patients receive medical nutrition therapy and of those, approximately 79% meet their dietary sodium goal and 82% meet their fluid intake goal. The dietitian has become a valued member of the heart failure team. This team has succeeded in decreasing hospital admissions by 30%, hospital days by 42%, and average length of stay by 17%.