Patients with heart failure (HF) who experience low health literacy are at an increased risk of hospitalization and mortality.

This finding has significant clinical and public health implications and suggests that assessing and intervening on an individual's understanding of their own health could improve heart failure outcomes, according to a meta-analysis published May 25 in JACC: Heart Failure.

While previous studies have suggested that low health literacy in HF patients could be associated with higher risk of mortality, hospitalizations and emergency department (ED) visits for all causes, the results have been inconsistent.

This is the first meta-analysis of its kind to adjust for important potential confounders to obtain a clearer understanding of the association.

Researchers, with the assistance of a medical librarian, conducted a systematic review across EMBASE, MEDLINE, PsycInfo and EBSCO CINAHL databases from inception to Jan. 1, 2019.

They included 15 observational and interventional studies (11 with an overall high methodological quality) that evaluated the impact of health literacy among patients 18 years or older with HF not using a left ventricular assist device on at least one of these outcomes: mortality, hospitalizations and ED visits for all causes.

Interventional studies evaluated interventions for patients who had inadequate health literacy or included a health literacy-sensitive intervention.

In the studies included in the meta-analysis, objective measurement tools evaluated the degree to which a patient comprehends medical information and subjective tools evaluated how much a patient thinks they understand.

Results showed that among the observational studies, 9,171 patients with HF were included, of whom 2,207 (24%) had inadequate or marginal health literacy.

Inadequate health literacy was associated with higher unadjusted risk for mortality, hospitalizations and ED visits.

When the adjusted measurements were combined, inadequate health literacy remained statistically associated with mortality (risk ratio [RR], 1.41; 95% confidence interval [CI], 1.06-1.88) and hospitalizations (RR, 1.12; 95% CI, 1.01-1.25).

Among the four interventional studies, two effectively improved outcomes among patients with inadequate health literacy.

"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," says Lila J. Finney Rutten, PhD, an author of the study.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support

Keywords: Health Literacy, Heart-Assist Devices, Public Health, Hospitalization, Hospital Mortality, Heart Failure, Risk, Emergency Service, Hospital

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