Poor health literacy linked to higher heart failure mortality: Study

Heart failure patients with a low degree of health literacy have an increased risk of death, according to a new study.

Health literacy is defined as the degree to which individuals can obtain, process and understand basic health information and services needed to make appropriate health decisions.

"Although patients with heart failure are frequently hospitalised, much care for heart failure is performed on a daily basis by individual patients outside of the hospital. This self-care requires integration and application of knowledge and skills. Therefore, an adequate level of health literacy is likely critical in ensuring patient compliance and proficiency in self-management. Little is known about the association between health literacy and outcomes among patients with heart failure," said the authors, led by Pamela N. Peterson of the Denver Health Medical Centre, Denver.

Peterson and colleagues evaluated the association between low health literacy and all-cause mortality and hospitalisation among a population of outpatients with heart failure.

The study included patients with heart failure of an integrated managed care organisation who were identified between January 2001 and May 2008, were surveyed by mail and underwent follow-up for a median (midpoint) of 1.2 years.

Health literacy was assessed using three established screening questions and categorised as adequate or low.

Responders were excluded if they did not complete at least 1 health literacy question or if they did not have at least 1 year of enrollment prior to the survey date.

Of the 2,156 patients surveyed, 1,547 responded (72% response rate). Of 1,494 included responders, 262 (17.5%) had low health literacy.

Patients with low health literacy were older, of lower socioeconomic status, and less likely to have at least a high school education. They were also more likely to have coexisting illnesses such as diabetes, hypertension, chronic pulmonary disease, and stroke.

There were a total of 124 deaths during follow-up, with 46 deaths (17.6%) in the low health literacy group and 78 (6.3%) in the adequate health literacy group.

There were a total of 366 hospitalisations during follow-up, with 80 hospitalisations (30.5%) in the low health literacy group and 286 (23.2%) in the adequate health literacy group.

The researchers concluded that low health literacy was independently associated with an increased risk of mortality.

The authors suggest that routine assessment of health literacy may help to identify a greater number of patients at risk for adverse outcomes.

The study appears in the current issue of Journal of the American Medical Association.