Does Meal “Dose” Matter in Heart Failure? The MEDIMEALS Trial (7 vs 21 Meals/Week)

Quick take for clinicians: In the MEDIMEALS crossover trial, heart failure patients at malnutrition risk received either 7 or 21 home-delivered medically tailored meals per week after discharge.

The study primarily assessed nutritional status improvements; early reports also suggest readmissions were below local/national averages during program periods, warranting larger effectiveness trials.
Sources: BMC Nutrition; trial registry; institutional news release.
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Study Design at a Glance

• Population: Adults with heart failure at malnutrition risk or with malnutrition, immediately post-hospital discharge.
• Design: Random-order crossover feeding trial comparing 7 vs 21 meals/week; each participant experienced both “doses.”
• Intervention: Heart-healthy, protein-adequate, sodium-conscious meals delivered to the home.
• Primary outcomes: Nutritional metrics (e.g., malnutrition risk scores, weight stability); secondary signals for care utilization.
• Registration & publication: NCT06142903; peer-reviewed in BMC Nutrition (2025).
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Key Findings

• Nutritional status improved during MTM support, with indications that the higher “dose” may better sustain calorie/protein adequacy for some patients.
• Readmission signal: Institutional reporting noted readmissions were below local and national averages during program windows (exploratory, non-comparative).
• Feasibility & adherence: Home delivery plus clear sodium/protein targets supported adherence in the early post-discharge period.
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How to Act on This Evidence
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A Pragmatic “Dose” Pathway for HF Discharges

• Identify HF patients with malnutrition risk (e.g., screening scores, recent weight loss) or IADL limitations.
• Start with 7–14 meals/week for 4–8 weeks if budget-constrained; consider 21/week in the highest-risk patients to lock in nutrition early.
• Pair with RD telehealth to titrate sodium, protein, fluid guidance, and troubleshoot barriers.
• Track outcomes: 30- and 90-day readmissions, ED visits, weight, malnutrition scores, patient-reported energy/function.
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Operational & Payer Considerations

• Workflow: Add MTM referral prompts to HF discharge order sets; pre-schedule RD follow-ups.
• Coverage: Clarify payer policies, use HSA/FSA where applicable; align with value-based HF programs.
• Logistics: Ensure delivery reliability and cold-chain integrity; measure patient satisfaction with menu fit and timing.
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Fast onboarding • Evidence-aligned menus • Outcome tracking
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FAQs

Who is the ideal candidate after HF discharge?

Patients with documented malnutrition risk, recent weight loss, or functional barriers to cooking/shopping—especially within 30 days of hospitalization.
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How many meals per week should we prescribe?

Start with 7–14 meals/week for most; consider 21/week for high-risk patients needing full meal coverage during the vulnerable post-discharge window.
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Which outcomes should we monitor?

Malnutrition risk scores, weight stability, 30/90-day readmissions and ED visits, and patient-reported energy and diet adherence.