Nutrition Guidelines for heart failure patients: HFSA 2019 Scientific Sessions

Keeping in mind the dietary requirements of heart failure (HF) patients, the Heart Failure Society of America (HFSA) has released a new nutritional guideline.

The guideline, presented at the HFSA 2019 Scientific Sessions, is centred on obesity management, dietary composition and counselling, and cachexia malnutrition.

Amanda Vest, Tufts Medical Center, led a multi-disciplinary writing group several times a day, including cardiologists, dietitians, nurses and pharmacists to assemble a consensus statement on nutrition for patients with heart failure. This guideline holds significance given the lack of detailed nutrition recommendations and existing heart failure guidelines.

Key Recommendations include:

• DASH or Mediterranean diet, as well as plant-based diets should be considered for HF patients.


• Sodium intake should be limited to 2-3 grams per day.


• Bariatric surgery should be considered for all eligible patients, which has been shown retrospectively in several different cohorts to cut the risk of incident heart failure in half.


• Saturated fats should be replaced with modern polyunsaturated fats such as olive oil and fish oil, there are no longer specified limits on saturated fats.


• Processed meats, refined carbohydrates and sweetened beverages should be taken in limited amount and the authors strongly recommend against the consumption of any trans fats.


• Patients with heart failure and the body mass index of 35 or above should receive counselling on a calorie-restricted diet that aims for 5-10% weight loss.


• All patients with heart failure should receive a 30 to 60-minute dietician consultation with a follow-up encounter in 4 to 6 weeks.

“So, the concept of food as medicine has gotten momentum lately that leveraging the diet to prevent or treat heart failure remains, in my opinion, a missed opportunity for so many of our patients with heart failure,” Vest said.

Vest said dietary consultation is a key tenant in the new recommendations.

Vest explained that the government’s mind plate approach to diet, which includes suggestions on healthy dietary composition and appropriate portion sizes, was created using controversial evidence, leading to other guides emerging.

“And so, for example, the Harvard School of Public Health has released its own edited version that replaces the milk with water as a preferred beverage, and also adds a serving of healthy fat,” she said. “The 2019 [American College of Cardiology/American Heart Association] Primary Prevention Guidelines about data the concept of a heart-healthy diet is the most recent evidence from epidemiological data.

“These guidelines emphasize the diet rich in fruits, vegetables, legumes, nuts, whole grains and fish, due to the associations between these foods and lower rates of atherosclerosis, muscular disease.

Low-sodium diet

A low-sodium diet includes no more than 2,000 to 3,000 milligrams (mg) of sodium per day. That is the same as 2 to 3 grams of sodium a day. To give you an idea of how much that is, 1 teaspoon of salt = approximately 2,300 mg sodium.

People with mild heart failure (no or mild symptoms with vigorous or moderate exercise) are usually asked to limit their sodium intake to 3,000 mg per day.

People with moderate to severe heart failure (symptoms with light exercise, household chores or at rest) are usually asked to limit their sodium intake to 2,000 mg per day.