BackgroundThere are limited data to inform dietary recommendations in persons with heart failure (HF).ObjectivesThe aim of this study was to examine associations between consumption levels of 11 common foods, and a healthy diet pattern, with clinical outcomes in a HF population.MethodsThis analysis was a substudy of 3,798 participants from 25 countries enrolled in the multinational G-CHF (Global Congestive Heart Failure) registry with dietary data collected through food frequency questionnaires. Associations were examined between consumption levels of 6 plant-based foods (fruits, vegetables, legumes, nuts, whole grains, and refined grains) and 5 animal-based foods (fish, poultry, unprocessed red meat, eggs, and dairy) with the primary composite outcome of death or HF hospitalization and its components. Also examined was the association between an overall healthy diet pattern (measured by using a mAHEI [modified Alternative Heathy Eating Index]) and these outcomesResultsA total of 1,236 participants had a primary outcome event, 890 participants died, and 593 were hospitalized for HF. Higher legume intake (HR: 0.85 [95% CI: 0.73-0.99] for 0.1 to <0.5 serving per day and HR: 0.80 [95% CI: 0.65-0.98] for ≥0.5 serving per day vs <0.1 serving per day) was associated with a lower risk of the primary outcome. Moderate vegetable intake (1 to <3 servings per day) was associated with a lower risk of HF hospitalization (HR: 0.77 [95% CI: 0.61-0.97]) compared with <1 serving per day. Higher refined grain intake was associated with a higher risk of hospitalization for HF (HR: 1.56 [95% CI: 1.19-2.05] for 1-3 servings per day and HR: 1.76 [95% CI: 1.30-2.39) for >3 servings per day vs <1 serving per day). Associations with other foods, as well as with the mAHEI, were neutral.ConclusionsIn persons with HF, higher legume and vegetable intake were each associated with a lower risk of adverse clinical outcomes, whereas higher refined grain intake was associated with a higher risk of adverse clinical outcomes.