Can “Food-as-Medicine” Help Patients With Heart Failure?

For patients recovering from a heart failure (HF) hospitalization, access to healthy food is often a major challenge—and a potential opportunity for better outcomes.¹ A new randomized clinical trial tested whether delivering medically tailored meals or fresh produce could improve recovery, finding strong patient engagement and satisfaction, but no significant reduction in 90-day readmissions or emergency visits.

This open-label factorial randomized clinical trial is published in JAMA Cardiology.

“We conducted a pilot factorial randomized clinical trial to determine the feasibility and acceptability of 2 different forms of food supplementation, medically tailored meals or fresh produce, vs usual care in patients who were recently hospitalized with HF,” wrote the researchers of the study. “We also explored the association of food supplementation with clinical outcomes and quality of life. Finally, we evaluated whether conditioning the food intervention to participants’ clinic attendance and medication pharmacy fills was associated with better outcomes than unconditional delivery.”

Food insecurity—defined as limited or uncertain access to adequate and nutritious food—has been increasingly recognized as a risk factor for adverse outcomes in HF.² Patients experiencing food insecurity are more likely to have poor dietary quality, medication nonadherence, and difficulty managing comorbidities, which can contribute to higher rates of hospitalizations and mortality. Addressing food insecurity may therefore be a critical component of comprehensive heart failure management.

The study was conducted across 2 hospitals in Dallas, Texas, between April 2024 and October 2025.¹ Investigators enrolled 150 adults within 14 days of discharge following a HF hospitalization and followed them for 12 weeks. Participants were randomized to receive medically tailored meals, fresh produce, or usual care, and those in the food supplementation groups underwent a second randomization to either conditional delivery—linked to clinic attendance and medication adherence—or unconditional delivery. Patients with prior heart transplant, left ventricular assist devices, inotropic support at discharge, current meal program participation, or inability to receive deliveries were excluded.

The primary outcome was a composite of HF-related readmissions or emergency department (ED) visits within 90 days, alongside implementation measures such as delivery completion, adherence, and acceptability.

At 90 days, food supplementation did not significantly reduce HF-related readmissions or ED visits compared with usual care, with 23 events among 100 participants in the intervention groups vs 9 events among 50 in usual care (adjusted rate ratio, 1.09; 95% CI, 0.49-2.43; P = .83). However, implementation outcomes were strong: delivery completion reached 93.6%; retention was 96.0%; and participants reported consuming meals, with a mean (SD) of 4.7 (2.4) days per week and fresh produce of 5.5 (2.3) days per week. Fresh produce was rated more favorably than medically tailored meals (Net Promoter Score, 8.6 vs 7.3; P = .02).

Although the primary outcome was neutral, a hierarchical composite end point—including all-cause mortality, total HF hospitalizations or ED visits, and a 10-point improvement in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score—favored food supplementation (win ratio, 1.21; 95% CI, 1.14-1.29; P < .001). Conditioning food delivery on health care engagement did not significantly affect HF-related outcomes.

However, the researchers acknowledged some limitations. First, this trial was underpowered to detect meaningful differences in HF outcomes and may not generalize to other food interventions due to variability in meal content and duration. Second, the open-label design and reliance on quantitative measures may have introduced bias, and formal nutritional status and local food environment were not assessed. Moreover, the 3-month intervention may have been too brief to observe the full clinical impact.

Despite these limitations, the researchers believe the trial demonstrates that food-as-medicine interventions are both feasible and well accepted among patients recently hospitalized with HF, particularly in populations with high rates of food insecurity. Yet, the lack of impact on short-term readmissions highlights the complexity of HF management and suggests that nutrition interventions alone may be insufficient to shift acute care utilization in the near term.

“Food supplementation did not reduce HF hospitalization or HF ED visits,” wrote the researchers. “These pilot findings can inform larger, multicenter trials investigating food supplementation in the post-discharge setting for patients with HF.”

References

1. Pandey A, Keshvani N, Coellar JD, et al. Food supplementation in patients hospitalized with heart failure. JAMA Cardiol. doi:10.1001/jamacardio.2026.0435

2. Grant JK, Ndumele CE. A hunger for action: the need to address the food environment in the evaluation and management of heart failure patients. Circ Heart Fail. doi:10.1161/CIRCHEARTFAILURE.122.010043