Home Meal Lifts Mood, Limits Risk For Cardiac Patients

Home delivered meals are helping those with heart disease reduce risk of depression, particularly during the pandemic. In the US, health insurers are beginning to pay for these meals as part of a health benefit.

Project Angel Food in California provides over 2,000 meals a week during the pandemic to the frail elderly and people with serious illnesses, such as heart disease, or those coming out of surgery like a bypass, up from 1,600 meals a week in 2019. God’s Love We Deliver, a New York non-profit, also reports a record number of home deliveries since March. But their outreach doesn’t simply end at delivering meals.

“We aren’t Amazon or UPS”, says Project Angel Foods Executive Director Richard Ayoub.

Volunteers also engage with recipients, ask them how they are doing, and then report anything problematic they see, like uneaten meals. That 5-minute connection is vital, Ayoub says, as 60% of Project Angel’s clients may not see anyone else that day. The homebound older woman with osteoarthritis, or the man dealing with a serious heart condition and both struggling with depression and anxiety – these can be lonely, at-risk populations. But with organizations like Project Angel Food, the meal delivery can act as an opener to something just as important: conversation.

Additionally, depression is common in those with heart disease and those coming out of cardiac surgery and can often leads to dehydration, which raises the risk of falls in the home.

Support for these home based initiatives was growing nationally even before the pandemic, coming not just from traditional federal and state funding, but also from health insurers and hospital systems realizing that “food is medicine”.  L.A. Care Health Plan, for example, which provides healthcare coverage for Los Angeles county residents, funded a refrigerated van and partial salary for a nutritionist for Project Angel Foods as part of an effort to provide meals tailored to those with chronic conditions such as HIV/AIDS, heart or kidney disease, and uncontrolled diabetes.

And while the value of the pre-meal companionship may be hard to quantify today, it is likely to be an increasingly relevant measure of the potential of these programs to limit costs like hospitalizations or falls or mortality.

In one landmark study, the continued presence of depression after heart surgery recovery increased the risk of death to 17 percent within 6 months after a heart attack vs. 3 percent in heart attack patients who didn’t have depression. During recovery from cardiac surgery, depression can intensify pain, worsen fatigue and sluggishness, or cause a person to withdraw into social isolation, says Leo Puzuelo, MD, who’s a physician in the Cleveland Clinic department of psychiatry. Patients who have had a cardiac event and have untreated depression after surgery also have increased morbidity and mortality.

Even the youth market’s experience with heart health and depression is relevant. A reported 29% of athletes developed eating disorders during their 7th to 11th grade year in one study, citing the pressures of remaining in top shape to ensure a scholarship. But from this disorder emerged complications, like lost weight which led to dangerously low heart rates and hospitalization in several cases. Average length of stay in a hospital is close to 3 weeks for these patients, our study found. A new model has been developed that combines virtual counseling and online support groups from companies like Talkspace combined with tailored healthy meals.

The connection between heart disease and depression is not just a US phenomenon. African and South American countries report high incidence of the diseases. Mortality due to ischemic heart disease increased in Ecuador, for example, from 2001-2016, and it is estimated that at least a quarter of those who died also suffered depression that started after their diagnosis. “It increases morbidity and mortality risk across genders, particularly when the person lacks a support system and education and access to counseling,” says Yvonne Swyth, a counselor for heart patients in Florida.

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