Impact of Dietary Pattern Interventions on Clinical Outcomes in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Abstract

Background and Purpose: Heart failure (HF) remains a leading cause of global morbidity and mortality, with current management heavily reliant on pharmacological and device-based therapies. However, the role of structured dietary interventions in improving HF outcomes has not been comprehensively evaluated. This systematic review and meta-analysis aimed to examine the impact of established dietary patterns—specifically the Mediterranean, DASH, and plant-based diets—on mortality, hospitalization, cardiac function, and patient-reported outcomes in adults with heart failure.

Methods: A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted from inception to October 2025. Randomized controlled trials and prospective cohort studies assessing the effects of structured dietary patterns in adult HF populations were included. Primary outcomes were all-cause mortality and HF-related hospitalizations. Secondary outcomes included changes in left ventricular ejection fraction (LVEF), N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels, New York Heart Association (NYHA) functional class, and Kansas City Cardiomyopathy Questionnaire (KCCQ) quality-of-life scores.

Results: Eighteen studies comprising 12,470 participants (mean age 64 ± 9 years, 39% women) met the inclusion criteria. Adherence to structured dietary patterns was associated with a significant reduction in all-cause mortality (RR 0.76, 95% CI 0.66–0.88, p < 0.001) and HF hospitalizations (RR 0.79, 95% CI 0.68–0.91, p = 0.002). A combined endpoint of death or hospitalization was reduced by 23% (RR 0.77, 95% CI 0.68–0.88). LVEF improved by 4.1% (95% CI 2.3–6.0), NT-proBNP levels decreased by 312 pg/mL (95% CI −428 to −198), NYHA functional class improved by 0.45, and mean KCCQ scores increased by 6.8 points, indicating better functional status and quality of life. Moderate heterogeneity (I² = 45%) was observed across analyses.

Conclusion: Structured dietary patterns such as the Mediterranean, DASH, and plant-based diets significantly improve survival, reduce hospital readmissions, and enhance cardiac function and quality of life among patients with heart failure.