| Objective To investigate the basic situation of nutrition and diet in patients with chronic heart failure,and to construct and apply personalized heart failure diet management program based on Evidence-Based,in order to optimize the nutrition management of heart failure and improve the clinical recovery of patients.Methods 1.A total of 106 patients with chronic heart failure who ate by mouth in the Department of Cardiology of Tertiary Hospital were investigated.Their nutritional status was evaluated by heart failure specific Mini Nutrition Assessment scale(MNA-HF),and their 3-day meals and extra meals were obtained by 24-hour dietary review.The total amount of nutrients in three meals and extra meals was calculated and compared with the dietary guidelines for Chinese residents(2016),Dietary Reference Intakes(DRIs)(2013)and the data of dietary survey in Jiangsu Province from 2010 to 2012.2.A usability questionnaire was designed from the perspectives of safety,effectiveness,maneuverability and social ethics to investigate nurses’ recognition of "Nutrition Management Program For Patients With Chronic Heart Failure" [1].The expert group discussed Chen Yuanyuan’s " Nutrition Management Program For Patients With Chronic Heart Failure " based on Evidence-Based from four aspects of evidence feasibility(F),appropriateness(A),meaningfulness(M)and effectiveness(E).By combining the actual clinical situation,the evidence items included in this study program were carefully selected to form the corresponding first draft of the diet management plan.After the first draft of this plan was examined and revised by the members of the expert group,the diet management plan for patients with chronic heart failure was finally formed.Based on the Ottawa evidence application model,this paper comprehensively analyzes the possible obstacles in the implementation process of the program before the application of this program,and formulates the corresponding action strategy to ensure the normal practice in the later stage of the program.3.According to the NYHA cardiac function classification,80 patients with chronic heart failure who ate orally were divided into the control group and the experimental group at 1:1.The intervention time of the two groups was within 3 months from admission to discharge;the control group received routine nutrition management,while the experimental group provided personalized dietary nutrition management for patients with heart failure strictly according to the dietary plan developed in this study on the basis of measures in the control group;evaluation indicators include: cardiac function: BNP,LVEF and NYHA cardiac function classification;nutritional status: BNP and MNA-HF score;re-admission status.Results 1.According to the evaluation of MNA-HF,61.32% of the patients with chronic heart failure who ate orally were at risk of nutrition or were malnourished.The daily intake of vegetables,soybeans and nuts was in line with the recommendations of the guidelines;the intake of cereal potatoes and mixed beans,fruits,milk and dairy products did not meet the recommended standards;the intake of livestock and poultry meat,aquatic products,eggs,oils and salts exceeded the recommended standards.The daily energy intake is about 1270.15 kcal,the energy supply ratio of protein and fat exceeds the recommended upper limit of DRIs,and the energy supply ratio of carbohydrates does not reach the recommended lower limit;CHF patients’ daily intake of sodium and iron 6803.34 mg and 16.65 kcal respectively exceeds 110% of the recommended intake or appropriate intake;daily intake of vitamin B1 and potassium 0.63 mg and 1537.69 kcal does not reach 90% of the recommended intake or appropriate intake.2.According to the evaluation,there are 56 pieces of dietary management evidence applicable to patients with heart failure by oral intake in "Nutrition Management Program for patients with chronic Heart failure" [1].According to the results of the questionnaire on clinical availability,the consent rate of medical staff in terms of safety and effectiveness of items 7 of Nutrition screening and Evaluation and item 3 of Energy requirements of the program is less than 80%.The consent rate of medical staff in terms of operability of items 9 of Nutrition screening and Evaluation and items 1 and 2 of Energy requirements of the program is less than 80%.In terms of ethics,the consent rate of nurses with 56 pieces of evidence reached 100%.The results of the FAME seminar showed that the recognition rate of the feasibility,suitability,clinical significance and validity of 52 pieces of evidence was more than 90%,which was included in the evidence entry of this study program.After being examined and revised by the members of the expert group,a dietary nutrition management plan was formed for patients with chronic heart failure after oral intake.Through the comprehensive analysis of the team members,it is found that there may be four obstacle factors in the practice process of this research program,and the corresponding action strategies are formulated respectively to ensure the normal practice in the later stage of the plan.3.There was no statistical difference in general data,cardiac function and nutritional status between the two groups at baseline,but after 3 months of intervention from admission to discharge,the levels of albumin,LVEF,BNP,NYHA cardiac function and readmission in the experimental group were better than those in the control group.There was no statistical difference in the MNA-HF score between the two groups at baseline,but in terms of time effect,the MNA-HF score of the two groups did not change significantly with the passage of time(P < 0.276).In terms of intergroup effect,the MNA-HF score of the experimental group was higher than that of the control group at different time points.There were interactive effects between different intervention groups and different follow-up time(P < 0.05),and the effect of the experimental group was better than that of the control group.Conclusions 1.The nutritional status of patients with chronic heart failure who take food by mouth is poor,and their dietary intake is worrying,so there is an urgent need for dietary intervention to improve their nutritional status.2.The dietary nutrition management program of patients with chronic heart failure based on evidence-based oral intake can improve the nutritional status of patients,improve the related indicators of cardiac function and reduce the rate of readmission. |
