Limited health literacy associated with a higher risk of death in heart failure patients

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According to research published in JACC: Heart Failure, patients with heart failure who experience low health literacy are at an increased risk of hospitalisation and mortality. A press release reports that this finding has significant clinical and public health implications and suggests that assessing and intervening upon an individual’s understanding of their own health could improve heart failure outcomes.

Study authors Lila J Finney Rutten (Mayo Clinic in Rochester, USA) and colleagues state health literacy is the “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions”. Previous studies have suggested that low health literacy among patients with heart failure could be associated with a higher risk of mortality, hospitalisations and emergency department visits, but results have been inconsistent. Therefore, Finney Rutten et al sought to determine the effect of health literacy on mortality, while adjusting for important potential confounders, on hospitalisations and emergency department visits among heart failure patients; the first meta-analysis of its kind.

They, with the assistance of a medical librarian, conducted a systematic review across EMBASE, MEDLINE, PsycInfo and EBSCO CINAHL databases from inception to 1 January 2019. Both observational and interventional studies evaluated the impact of health literacy among patients 18 years or older with heart failure on mortality, hospitalisations and emergency department visits for all causes. Interventional studies evaluated interventions among patients with heart failure who had low health literacy. Among the observational studies, 9,171 heart failure patients were included, of which 2,207 (24%) had inadequate or marginal health literacy.

In the studies reviewed, health literacy was assessed using objective or subjective measures—objective health literacy measurement tools evaluate how much the patient comprehends medical information and subjective measurement tools evaluate how much the patients think they understand.

The authors found that low health literacy was associated with higher unadjusted risk for mortality (relative risk [RR]: 1.67, 95% confidence interval [CI]: 1.18, 2.36), hospitalisations and emergency department visits. In adjusted analyses, low health literacy remained statistically associated with mortality and hospitalisations, but no correlation was found for emergency department visits. Among the four interventional studies, two effectively improved outcomes for heart failure patients with low health literacy.

Finney Rutten comments: “Our findings showed that an inadequate level of health literacy is associated with increased risks in mortality and hospitalisation among patients with heart failure. Identifying health literacy as a factor that affects health outcomes and measuring its effect on patients with heart failure is essential to allocate more resources for, and research on, interventions to improve health literacy.”


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