Evaluating a dietetic educational intervention delivered to patients during hospital-based cardiac rehabilitation (CR)

Abstract Background/Introduction Cardiac rehabilitation (CR) is an outpatient chronic disease management model recommended in clinical practice guidelines for patients with all forms of atherosclerotic cardiovascular diseases (ASCVD). Nutrition counselling is a core component of the prevention of non-communicable diseases including cardiovascular disease. While striving to deliver care in line with clinical practice guidelines, it is equally important to communicate nutritional information in an accessible way which accommodates varying degrees of health literacy. Therefore, effective delivery of dietetic educational intervention is an integral part of CR. Furthermore, measurement of treatment effectiveness and patient satisfaction are also recognized as important indicators of healthcare quality. Purpose To evaluate the effectiveness of the nutritional intervention in CR by (a) assessing improvements in patient’s baseline nutritional knowledge post-intervention; and (b) evaluating patients’ satisfaction with the dietetic intervention provided during CR. Methods The group educational intervention was informed by ESC (2021) guidelines and delivered in a discursive manner with patients encouraged to play an active role in the process. To evaluate the intervention a short battery of measures were administered to patients pre and post intervention over a 4-month period (April-August 2023). The study-specific questionnaire was based on the validated GNKQ (General Nutrition Knowledge Questionnaire) which was specifically adapted for the CR population. Results Participants were predominantly referred following Acute Coronary Syndrome (ACS), coronary artery disease (CAD) ± revascularization and valve disease (78% male, mean age 62 years). Thirty patients completed both the pre and post intervention evaluation measures (response rate 63%). Post intervention, 29 patients scored 60% on the nutritional knowledge measure (compared to 23 at baseline); 60% of patients were able to identify HDL as the good cholesterol (compared to 43% of patients not receiving the intervention). 77% of patients correctly answered the food labelling question after attending the dietetic session (compared to 63% of patients at baseline). 83% were also able to identify the recommended units of alcohol correctly compared to 47% of patients who did not receive the intervention. 18% of participants provided additional qualitative data which primarily indicated that patients viewed that their nutritional knowledge had improved but that further dietetic input was required. Conclusion Nutritional counselling is a core component of CR and the dietitian remains a vital member of the CR multi-disciplinary team. Although the dietetic intervention was successful in improving educational outcomes in some patients, resources should be directed to ensure patients receive optimal dietetic input and thus high-quality CR.