Geriatric Out of Hospital Randomized Meal Trial in Heart Failure

Inclusion Criteria:

66 male and female patients aged ≥ 55 years with history of systemic hypertension and acutely decompensated heart failure (ADHF; primary diagnosis for admission or secondary diagnosis after hospitalization for another reason). ADHF will be confirmed by the study physician and defined as a combination of symptoms, signs, and HF-specific medical treatments. Specifically, ADHF will require that all four of the following conditions are met:

≥1 symptom of HF (dyspnea, fatigue, orthopnea, paroxysmal nocturnal dyspnea) has worsened from baseline
≥ 2 signs of HF (pulmonary congestion on exam and/or chest X-ray, elevated jugular venous pressure, peripheral edema or rapid weight gain, and/or increased B-type natriuretic peptide (BNP; ≥100 pg/ml)
change in medical treatment specifically targeting HF (diuretics, vasodilators, and/or neurohormonal modulating agents)
no other cause of the patient's symptoms and signs is apparent

Exclusion Criteria:

persistent hypotension during hospitalization or excessive risk of hypotension from the study diet as judged by the investigators or systolic BP <110 on discharge
use of inotropic therapy at hospital discharge,
severe valvular heart disease as the primary etiology of the patient's HF syndrome
uncontrolled hypertension defined as the following criteria for the last 24 hours prior to discharge (systolic BP >180 mmHg or diastolic BP >100 mmHg)
having two or more results of a serum potassium >5.0 mmol/L during hospitalization or history of serum potassium >6.0 mmol/L, and/or at an excessive risk of hyperkalemia as judged by the investigators
severe renal insufficiency (estimated glomerular filtration rate <30 ml/min/1.73m^2 at discharge)
severe anemia (hemoglobin < 9 gm/dl)
length of stay <48 hours or >14 days
co-morbidity with expected survival < 12 months
active alcohol or substance abuse
history of persistent noncompliance with treatment recommendations as judged by the investigators