Study Questions: What are the clinical outcomes of patients after an acute episode of acute heart failure according to their adherence to a Mediterranean diet?

Methods: The MEDIT-AHF study prospectively recruited consecutive acute heart failure patients in seven Spanish emergency departments (EDs). Patients were included if they or their relatives were able to answer a 14-point score of adherence to the Mediterranean diet, which classified patients as adherents (≥9 points) or nonadherents (≤8 points). The primary endpoint was all-cause mortality at the end of follow-up, and secondary endpoints were 1-year ED revisit without hospitalization, rehospitalization, death, and a combined endpoint of all these variables for patients discharged after the index episode. The authors accepted statistical significance if 95% confidence interval (CI) of hazard ratios (HRs) excluded the value 1 or the p value was <0.05.

Results: The study cohort included 991 patients (mean age of 80 ± 10 years, 57.8% women), 52.9% (n = 523) of whom were adherent to the Mediterranean diet. The investigators found that after a mean follow-up period of 2.1 ± 1.3 years, no differences were observed in survival between adherent and nonadherent patients (HR of adherents [H Radh ] = 0.86; 95% CI, 0.73-1.02). The 1-year cumulative ED revisit for the whole cohort was 24.5% ([H Radh ] = 1.10; 95% CI, 0.84-1.42), hospitalization 43.7% ([H Radh ] = 0.74; 95% CI, 0.61-0.90), death 22.7% ([H Radh ] = 1.05; 95% CI, 0.8-1.38), and combined endpoint 66.8% ([H Radh ] = 0.89; 95% CI, 0.76-1.04). There were no statistically significant differences in mortality ([H Radh ] = 0.94; 95% CI, 0.80-1.13) and persistence of lower 1-year hospitalization for adherents ([H Radh ] = 0.76; 95% CI, 0.62-0.93), after adjusting for age, arterial hypertension, peripheral arterial disease, previous episodes of acute heart failure, treatment with statins, air-room pulse-oximetry, and need for ventilation support in the ED. There was no interaction between the presence or absence of changes in dietary habits throughout the period and ED revisit, rehospitalization, and combined events, with p values of 0.46, 0.73, and 0.86, respectively (as all surveyed patients were alive, interaction for long-term and 1-year post-discharge mortality could not be assessed).

Conclusions: The study authors concluded that adherence to the Mediterranean diet did not influence long-term mortality after an episode of AHF, but it was associated with decreased rates of rehospitalization during the next year.

Perspective: This prospective study, although of short duration, suggests that Mediterranean diet does not influence mortality associated with acute heart failure. Large randomized clinical trials will be needed to definitely reject the merits of Mediterranean diet in acute heart failure.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Nonstatins, Novel Agents, Statins, Acute Heart Failure, Diet, Hypertension

Keywords: Diet, Diet, Mediterranean, Emergency Service, Hospital, Geriatrics, Heart Failure, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertension, Mortality, Oximetry, Patient Discharge, Peripheral Arterial Disease, Primary Prevention