eNutriCardio improves diet quality in NHS cardiac rehabilitation patients: a randomised controlled study

Cardiovascular disease (CVD) is a leading cause of death in the UK, and cardiac rehabilitation (CR) is recommended post-myocardial infarction to improve outcomes. However, uptake remains low due to referral barriers, logistical challenges, and limited resources. Poor diet is a modifiable risk factor for CVD, yet access to tailored nutrition support within CR is limited. NICE guidance recommends personalised dietary advice as part of CR (1) , and remote delivery of personalised nutrition may offer a scalable solution to improve diet quality and support equitable CR access. eNutriCardio is a novel web-based personalised nutrition advice (PNA) tool adapted from the validated eNutri web-app (2) , originally developed for the general population (3) . This study investigated the effectiveness of eNutriCardio in improving diet quality in UK NHS patients offered CR. Patients eligible for CR completed a validated food frequency questionnaire (FFQ) via eNutriCardio shortly after their cardiac event or procedure. Participants were randomised to receive either usual care (including CR programme) (control) or usual care plus eNutriCardio PNA (intervention). The PNA was tailored to individual FFQ responses and an 11-component diet quality score (DQS), providing food-based recommendations to improve their three lowest scoring DQS components, where a higher score reflects greater adherence to UK dietary guidance. Intervention participants received coaching emails at weeks 2, 4 and 8, prompting participants to set and reflect on healthy eating intentions. After 12 weeks, both groups repeated the FFQ and provided feedback. An independent samples t-test compared change in overall DQS between groups (primary outcome). Targeted analysis (paired samples t-tests) explored whether change in DQS differed between PNA components that intervention participants intended to change versus components they either did not intend to change nor received advice about. The study was registered with ClinicalTrials.gov (ID: NCT05449769) and conducted according to the principles outlined in the Declaration of Helsinki. Twenty-seven participants were included in the present analysis (intervention: n=13; control: n=14). Baseline characteristics were not significantly different between groups: mean age 61 years (SD 8), 82% male, and mean BMI 27.9 kg/m 2 (SD 5.4). Intervention participants showed a 54% greater increase in total DQS (+21.2 points, out of 100) compared with control participants (+9.8 points) after 12 weeks (p=0.036). Within the intervention group, changes in DQS component scores were 80% higher for components participants intended to change versus those without intentions or advice (p≤0.001). No significant difference in BMI change was observed. All intervention participants agreed that eNutriCardio PNA helped them eat healthier and should be offered to all CR-eligible patients. Adding eNutriCardio PNA to usual care improved diet quality significantly more than usual care alone in NHS patients offered CR. This digital tool may enhance CR by offering a remote, personalised nutrition solution for patients unable to attend in-person programmes.