Practice-based observations of barriers to dietary adherence among patients hospitalized with congestive heart failure in a safety-net hospital

Congestive heart failure (CHF) disproportionately affects minority and low-income populations; however, practice-based observations on barriers to dietary adherence remain limited, particularly among African American patients in safety-net settings. This short report presents practice-based observations derived from routine bedside nutrition counseling sessions with 26 adults hospitalized for CHF at a safety-net hospital. Counseling documentation was reviewed and descriptively synthesized to identify recurrent challenges to dietary adherence. Patients frequently demonstrated confusion regarding sodium restriction and nutrition label interpretation and received inconsistent guidance from healthcare providers. Beyond knowledge gaps, socioeconomic and structural barriers, including financial hardship, limited access to healthy foods, reduced mobility, and lack of home support, further impeded dietary adherence. These findings highlight the complex interplay between individual, social, and structural factors that shape nutrition self-management in heart failure. Addressing these barriers through culturally tailored, multidisciplinary interventions that integrate nutrition education with social support and resource linkage may enhance adherence, reduce readmissions, and improve equity in CHF outcomes within underserved populations.