The comparative effectiveness of 7 versus 21 home-delivered Medically Tailored Meals to improve malnutrition risk in malnourished patients with heart failure: A random order crossover feeding trial (MEDIMEALS)

Abstract Background: Heart failure (HF) is frequently associated with risk of malnutrition or frank malnutrition. The delivery of medically tailored meals (MTM) to the homes of patients with HF and malnutrition risk or a malnutrition diagnosis after hospital discharge holds promise for improving outcomes. Methods: A random order crossover study was designed to compare the delivery of 7 versus 21 MTM for four weeks each to patients discharged from the hospital with HF and malnutrition risk. Telephone surveys were conducted at baseline, 30 and 60 days post-discharge to evaluate change in Malnutrition Screening Tool (MST), American Heart Association (AHA) diet goals, sarcopenia risk (SARC-F), and 30-day readmissions. Results: Forty-six patients were enrolled. Patients had reduced odds of having high MST scores relative to the baseline score at one and two months (OR 0.18, 95% CI 0.04-0.74 and OR 0.21, 95% CI 0.05-0.99, respectively). The AHA diet goal score did not change from baseline at either one or two months. Sarcopenia risk scores improved over time (p=0.01), decreasing by 0.43±0.2 units by one (p=0.03) and 0.59±0.21 units by two months (p=0.007) regardless of the number of MTM provided. Readmissions by 30 days were not significantly different based on the number of MTM provided per week (9% for 21 MTM vs 12.5% for 7 MTM). Conclusion: The provision of at least seven medically tailored meals per week in the early window after hospital discharge to patients with HF and malnutrition or malnutrition risk is a promising strategy to reduce malnutrition, sarcopenia risk, and improve patient quality of life.