Dietary Approaches for Heart Failure and Diabetes

This article reviews dietary approaches for patients with heart failure and diabetes, focusing on dietary patterns and individualized needs. It also discusses the effectiveness of disease management programs for reducing heart failure hospital readmissions.

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William’s Case Study
Part 1-Annotated Bibliography
Butler, T., Georgousopoulou, E. N., & Mellor, D. (2018). Dietary approaches for patients with
heart failure and diabetes. Practical Diabetes, 35(4), 127–130a. https://doi-
org.libraryproxy.griffith.edu.au/10.1002/pdi.2179
Butler, Georgousopoulou & Mellor (2018) reviewed what is known about nutritional
management for individuals with both diabetes and heart failure (HF) to recommend a dietary
approach for them. The study focuses on the emerging evidence that patients living with both
heart failure and diabetes can benefit from dietary pattern approach. The study found that a
dietary approach for individuals living with HF and diabetes should focus on dietary patterns and
food rather than just nutrients, have low carbohydrate diets, and should focus on individual
specific needs and be acceptable and compatible with the patient lifestyle. The study was unable
to outline optimal dietary guideline for patients living with both diabetes and chronic heart
failure. The study has recommended the best dietary management approach from patients with
diets and what is known for chronic heart failure and puts an emphasis on individualized
nutrients to meet specific patient needs. The information from this study can be used to advice a
patient who is living with both chronic HF and diabetes.
Gorthi, J., Huntera, C. B., Mooss , A. N., Alla, V. M., & Hilleman, D. E. (2014). Reducing heart
failure hospital readmissions: A systematic review of disease management programs.
Cardiology Research, 5, 126-138. http://dx.doi.org/10.14740/cr362w
The authors of this study aimed to find out the most effective disease management program
(DMP) for people living with chronic heart failure. The study undertook a systematic review that
identified randomized controlled trails of heart failure disease management programs that
included outpatient clinic intervention, home care, non-invasive and invasive telemonitoring, and
structured telephone support. The study found that home visits and out patients care was
effective for reducing readmission of patients with heart failure, they have a drawback in terms
of cost and accessibility. Telemanagement and telephone support follow up were found to have
potential to reach many people and at a reasonable cost but structured telephone support does not

reduce all cause hospitalization and all cause mortality. Non invasive telemonitoring reduce heart
failure hospitalization all cause mortality. Lastly, invasive telemonitoring has potential for
reducing heart failure hospitalization but was only supported by one study. The study
demonstrated inconsistent results about generalizing a disease management program for all
patient with heart failure. This study is relevant and it review can be used to develop with
diseases management program is fit for a specific patient living with chronic heart failure.
Molloy, G. J., O'Carroll, R. E., Witham, M. D., & McMurdo, M. E. T. (2012). Interventions to
enhance adherence to medications in patients with heart failure: A systematic review.
Circulation Heart Failure, 5, 126-133.
http://dx.doi.org/10.1161/CIRCHEARTFAILURE.111.964569
The authors of this study undertook a systematic review to identifying and summarizing the
effectiveness of interventions strategies that can enhance the adherence of medications in chronic
heart failure (CHF) populations. The study acknowledges there is need for intervention strategy
to ensure patients of heart failure take their prescription to manage the condition. The authors
used 16 randomized studies and controlled trails that contained 3305 patients’ data with chronic
heart failure. The study used published studies and used guidelines developed by Cochrane
Collaboration to avoid biasness. The authors established that adherence to medication among
people with CHF can be enhanced by using a range of intervention strategies. The study was not
able to undertake quantitative meta-analysis because it was impossible. The study also used only
one other published study that had used meta-analysis. The study is relevant to the understanding
of the association that exists between medication adherences and health outcomes and
interventions to enhance adherences that help to managed chronic heart failure.
Part Two- Justification
The first study chosen was dietary approaches for a patient with both diabetes and heart failure
condition. This study was chosen for two main reasons that related to William’s situation. First,
the study involves recommending on a diet approach for a patient with both CHF and diabetes.
William has both CHF and hypertension and needs a recommendation on diet in order to manage
his conditions. Nutrition management is an important aspect in managing heart failure and

hypertension (Bozkurt et al., 2016). Secondly, the study also touches on overweight for patients
with both CHF and diabetes. Overweight increases the risks of William’s heart condition twice
as compared to having a normal weight. In terms of quality, the article was published in a
credible journal of Practical Diabetes which is owned by the giant Jon Wiley and Sons Ltd
Company. The authors of the journal are also reputable academicians and practitioners with TB
being a member of the Steering Group for Heart UK and member of British Association for
Cardiovascular Prevention and Rehabilitation council while DM is a Board member of British
Diatec Association and member of the council of health professionals for Diabetes. The article
will add on the dietary approach that William will use to manage his condition such as
Mediterranean or Dash diets approach.
The second article was chosen to manage William’s condition readmissions to hospital.
Readmission s in hospitals comes with financial and medical burdens that necessitate need to
identify and evaluate strategies that reduce patient readmission (Bos-Touwen et al., 2015). The
study was chosen because it reviews different lifelong interventions that can be used to provide
palliative care to heart failure patients effectively and with minimal or reasonable cost. These
interventions for avoiding readmission are outpatient visits, structured telephone support, home
care, and invasive and non invasive telemonitoring (Conn, Enriquez, Ruppar, & Chan, 2016).
The article of credible standards that used generally accepted Cochrane Handbook and Meta-
analysis of Observational Studies in Epidemiology (MOOSE) guidelines to identify their studies.
The studies reviewed in the artcilce were also from reputable online databases of EBSCOHost,
PubMed and Cochrane Library from 1975-2014. In addition, one of its authors Dr. Hilleman
holds a membership of the speaker’s bureau for Bristol-Myers-Squibb and Malinckrodt. The
Gorth, Hunter, Mooss, Alla & Hilleman (2014) article is important in developing a disease
management program for William to reduce his readmission to hospital and manage his
condition for a quality life.
The third article chosen is Molloy, O’Carroll, Witham, & McMurdo (2012) on interventions that
can be used to enhance adherence to medications for individuals living with heart failure. The
article was chosen because it identifies strategies that are effective to enhance adherences for
medications for patients with heart failure condition. It is important that William takes his
medications as prescribed to avoid further complications. Heart failure health outcomes can be

improved by enhancing adherences to patients existing medications (Mosleh, & Almalik, 2016).
According to Elder et al., (2016) mortality and morbidity caused by heart failure can be
significantly be reduced by strict adherences to the condition’s prescription. The article uses
reputable sources and methodologies to select studies that were used for the systematic review.
The authors used Cochrane guidelines to select studies from MEDILINE, Cochrane Central
Register of controlled Trails, Embase, CINAHL, and PschInfo databases. The article used studies
containing data for 3305 patients who have chronic heart failure. The study therefore has
substantial evidence of interventions that can used to enhance medication adherences for heart
failure patients. The article will add on the effective intervention to enhance William adherence
to his existing prescription.
In general, the three articles chosen contribute to the management of William’s condition. The
important aspect for William is to effectively manage his diet and take his medication to control
his condition and improve his quality of life. It is also important to minimize William’s financial
and medical burden by reducing readmission.
Part 3-Recommendations
From the articles reviewed for evidence based guidelines for William’s condition, the following
is recommended; First, William needs a diet plan that aligns to both hypertension and heart
failure conditions. The diet has to be based on DASH or Mediterranean diet and be focused on
dietary pattern and foods (Tektonidis, Åkesson, Gigante, Wolk, & Larsson, 2016). William also
has to take low-carbohydrates diet and engage in physical activities within his exercise tolerance
in order to reduce weight. Eating planned diet plays a big part as a balancing act for people lining
with heart failure and diabetes (Marques et al., 2017). A planned diet can manage a chronic
disease by keeping the body healthy that reduces the risk of worsening condition. Secondly, there
is need for an intervention to ensure and enhance William adheres to his medications for heart
failure. Inadequate adherences to heart failure medications cause increased heart failure
exacerbations, high risk of readmission, reduced physical functions, and even death (Ruppar,
Cooper, Mehr, Delgado, & Dunbar‐Jacob, 2016). The intervention strategy should be intensified
patient care through structured telephone support or telemonitoring programs (Mosleh, &
Almalik, 2016). These strategies for disease management program will ensure William adheres
to his medications and the chronic condition is effectively managed. These recommendations

will therefore improve and manage William’s heart failure and diabetes conditions and prevent
him from getting visible peripheral oedema, breathless and tachycardia.
References
Bos-Touwen, I., Jonkman, N., Westland, H., Schuurmans, M., Rutten, F., de Wit, N., &
Trappenburg, J. (2015). Tailoring of self-management interventions in patients with

heart failure. Current heart failure reports, 12(3), 223-235.
https://doi.org/10.1007/s1189
Bozkurt, B., Aguilar, D., Deswal, A., Dunbar, S. B., Francis, G. S., Horwich, T., ... &
Rosendorff, C. (2016). Contributory risk and management of comorbidities of
hypertension, obesity, diabetes mellitus, hyperlipidemia, and metabolic syndrome in
chronic heart failure: a scientific statement from the American Heart
Association. Circulation, 134(23), e535-e578.
https://doi.org/10.1161/CIR.0000000000000450
Butler, T., Georgousopoulou, E. N., & Mellor, D. (2018). Dietary approaches for patients with
heart failure and diabetes. Practical Diabetes, 35(4), 127–130a. https://doi-
org.libraryproxy.griffith.edu.au/10.1002/pdi.2179
Conn, V. S., Enriquez, M., Ruppar, T. M., & Chan, K. C. (2016). Meta-analyses of theory use in
medication adherence intervention research. American journal of health
behavior, 40(2), 155-171. https://doi.org/10.5993/AJHB.40.2.1
Elder, D. H., Singh, J. S., Levin, D., Donnelly, L. A., Choy, A. M., George, J., ... & Lang, C. C.
(2016). Mean HbA1c and mortality in diabetic individuals with heart failure: a
population cohort study. European journal of heart failure, 18(1), 94-102.
https://doi.org/10.1002/ejhf.455
Gorthi, J., Huntera, C. B., Mooss , A. N., Alla, V. M., & Hilleman, D. E. (2014). Reducing heart
failure hospital readmissions: A systematic review of disease management programs.
Cardiology Research, 5, 126-138. http://dx.doi.org/10.14740/cr362w
Marques, F. Z., Nelson, E., Chu, P. Y., Horlock, D., Fiedler, A., Ziemann, M., ... & Mackay, C.
R. (2017). High-fiber diet and acetate supplementation change the gut microbiota and
prevent the development of hypertension and heart failure in hypertensive
mice. Circulation, 135(10), 964-977.
https://doi.org/10.1161/CIRCULATIONAHA.116.024545
Molloy, G. J., O'Carroll, R. E., Witham, M. D., & McMurdo, M. E. T. (2012). Interventions to
enhance adherence to medications in patients with heart failure: A systematic review.

Circulation Heart Failure, 5, 126-133.
http://dx.doi.org/10.1161/CIRCHEARTFAILURE.111.964569
Mosleh, S. M., & Almalik, M. M. (2016). Illness perception and adherence to healthy behaviour
in Jordanian coronary heart disease patients. European Journal of Cardiovascular
Nursing, 15(4), 223-230. https://doi.org/10.1177/1474515114563885
Ruppar, T. M., Cooper, P. S., Mehr, D. R., Delgado, J. M., & Dunbar‐Jacob, J. M. (2016).
Medication adherence interventions improve heart failure mortality and readmission
rates: systematic review and meta‐analysis of controlled trials. Journal of the American
Heart Association, 5(6), e002606. https://doi.org/10.1161/JAHA.115.002606
Tektonidis, T. G., Åkesson, A., Gigante, B., Wolk, A., & Larsson, S. C. (2016). Adherence to a
Mediterranean diet is associated with reduced risk of heart failure in men. European
journal of heart failure, 18(3), 253-259. https://doi.org/10.1002/ejhf.481