Assessment of the Low Referral Rate of Cardiologists to Dietitians/Nutritionists


  • Stephen Devries, MD Gaples Institute for Integrative Cardiology
  • Monica Aggarwal, MD Division of Cardiology; University of Florida, Gainesville
  • Kathleen Allen, MS, RD Geisel School of Medicine at Dartmouth
  • Penny Kris-Etherton, PhD, RD Department of Nutritional Sciences, Penn State University
  • Paul Theriot, BS, BA American College of Cardiology
  • Andrew M. Freeman Division of Cardiology, National Jewish Health



nutrition, preventive cardiology, dietitian, nutritionist, lifestyle medicine, preventive medicine


Background: Dietary factors are a leading contributor to cardiovascular disease. Cardiologists are ideally positioned to initiate dietary discussions with patients and to make appropriate referrals to dietitians/nutritionists, yet the frequency of such referrals is unknown.

Methods: A national survey was distributed to cardiologists to assess the frequency of their referrals to dietitians/nutritionists, their assessment of the efficacy of such referrals, and the perceived barriers to patient implementation of dietary changes following referral to dietitians/nutritionists.

Results: A total of 123 cardiologists responded to the survey. The majority of respondents (71%) reported that they referred 10% or fewer of their patients to dietitians/nutritionists. Cardiologists who participated in a nutrition-focused continuing medical education activity were nearly twice as likely to refer patients to a dietitian/nutritionist as those who did not. Thirty-two percent of cardiologists believed that 25% or more of their referred patients made significant gains in achieving dietary goals. Most cardiologists (63%) attributed the primary challenge to achieving dietary goals to “the patient’s lack of interest and motivation in making dietary changes” while 6% believed the lack of desired results were related to the quality of the counseling provided. Overall, 59% of cardiologists endorsed the belief that dietary interventions can improve outcomes to an equal or greater degree than pharmacologic therapy

Conclusion: Cardiologists reported making few referrals to dietitians/nutritionists; however, those who received continuing education in nutrition were significantly more likely to make a referral than those who did not receive nutrition education. The efficacy of referrals to dietitians/nutritionists was considered to be limited, which the majority of cardiologists attributed to a lack of patient interest and motivation—a belief that is not aligned with prior surveys of patient preferences.




How to Cite

Devries, S., Aggarwal, M., Allen, K., Kris-Etherton, P., Theriot, P., & Freeman, A. M. (2021). Assessment of the Low Referral Rate of Cardiologists to Dietitians/Nutritionists. International Journal of Disease Reversal and Prevention, 4(1), 8 pp.