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Heart-Healthy Diet Questionnaire Does Not Improve Referral of Patients to Nutritional Counseling

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A heart-healthy diet is essential for patients with heart disease, but a new questionnaire on diet quality does not improve referral rate to dietitians.
heart healthy diet questionnaire

heart healthy diet questionnaire

For patients with heart disease, a heart-healthy diet is a crucial adjunctive measure to medical care. A questionnaire that is given to a patient in the waiting room prior to a cardiology appointment can be a feasible method for assessing whether the patient consumes a healthy or unhealthy diet, a study in BMJ Nutrition, Prevention & Health suggests. But despite the utility of this screening approach, this questionnaire does not necessarily improve the rate at which cardiologists refer patients to a dietician for nutritional counseling.

Heart-Healthy Diet Questionnaire Fails to Improve Dietician Referral by Cardiologists

In this study, patients who attended a cardiology visit within NYU’s Prevention Center were administered a 10-item diet quality measure prior to their appointment. The measure included a self-rated diet quality question adopted from nutrition surveillance systems as well as a 9-item Mediterranean Diet Score (MDS) that asked participants about their intake of vegetables, fruit, whole grains, fish, legumes/beans, nuts/seeds, wine, fat, and red/processed meat.

The researchers counted the number of patients who were referred to a dietitian by their cardiologist for the 9 months following the implementation of the heart-healthy diet quality screener. All charts that reported a documented dietitian referral/visit contributed to this assessment. Since patients completed the questionnaire online through MyChart, scores were received by physicians in the electronic health record (EHR).

In total, 865 patients (mean age, 59 years; mean body mass index, 27.4 kg/m2) completed the diet quality questionnaire between December 2017 and August 2018. Approximately 18.5% of participants who completed the diet quality screener rated their diet as either fair or poor. The mean MDS was 5.6±1.8, which was considered moderate. Cardiologists referred only 2.5% (n=22) of patients to a dietitian for nutritional counseling.

Patients Responded Favorably to the Screener

Despite the low rate of referrals, approximately 66.7% of the 15 participants who completed satisfaction surveys said the screener was helpful, whereas 80% of participants reported satisfaction with the screener. Additionally, 66.7% responded that the screener improved their quality of care. This same proportion of patients said they considered changing their diet and/or exercise routine after consulting with their provider.

Physicians’ Response to the Screener

Only 33% of cardiologists who were invited to take part in this survey actually responded. While only a small proportion of physicians referred patients to a dietitian, most responding physicians said the screener was rated positively in relation to ability to integrate into the patient’s EHR.

The researchers of this study wrote that structured physician guidance on when and how to implement the screener could be helpful in the dietary assessment of patients with heart disease and other heart issues. This guidance may include recommendations on how to provide counseling or how to plan dietitian referrals according to screener scores, which may potentially lead to care improvements.


Beasley J, Sardina P, Johnston E, et al. Integrating a diet quality screener into a cardiology practice: assessment of nutrition counseling, cardiometabolic risk factors and patient/provider satisfaction. BMJ Nutrition, Prevention & Health. 2020 March 26.

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