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Health Literacy and Outcomes Among Heart Failure Patients
Quick Takes
- An inadequate level of health literacy is associated with higher risk for death and hospitalizations in HF patients.
- Screening for health literacy should be done in clinical practice to identify those HF patients who are at increased risk for adverse outcomes.
- Interventions to improve adverse outcomes among patients with inadequate health literacy have been proven to be effective, and therefore, should be implemented in clinical practice.
Study Questions:
Is health literacy associated with mortality, hospitalizations, or emergency department (ED) visits among patients living with heart failure (HF)?
Methods:
The study authors searched Embase, MEDLINE, PsycINFO, and EBSCO CINAHL from inception through January 1, 2019, with the help of a medical librarian. Eligible studies evaluated health literacy among patients with HF and assessed mortality, hospitalizations, and ED visits for all causes with no exclusion by time, geography, or language. The authors included observational studies that: 1) evaluated health literacy among patients with HF; 2) had ≥1 of these 3 outcomes: mortality, hospitalizations, and ED visits for all causes; and 3) focused on adult patients aged ≥18 years with HF not using a left ventricular assist device. They also included all interventional studies that: 1) proposed an intervention for patients with inadequate health literacy or a health literacy–sensitive intervention; 2) had ≥1 or a combination of these 3 outcomes: mortality, hospitalizations, and ED visits for all causes; and 3) were focused on patients aged ≥18 years with HF. They evaluated the association between inadequate health literacy and the following outcomes: mortality, hospitalizations, and ED visits for all causes.
Results:
The final study cohort included 15 studies, 11 with an overall high methodological quality. Among the observational studies, an average of 24% of patients had inadequate or marginal health literacy. Inadequate health literacy was associated with higher unadjusted risk for mortality (risk ratio [RR], 1.67; 95% confidence interval [CI], 1.18-2.36), hospitalizations (RR, 1.19; 95% CI, 1.09-1.29), and ED visits (RR, 1.17; 95% CI, 1.03-1.32). When the adjusted measurements were combined, inadequate health literacy remained statistically associated with mortality (RR, 1.41; 95% 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: a) Patients in the intervention group had a lower rate of combined death and hospitalization. This effect was larger among patients with low health literacy (incidence ratio [IRR], 0.39; 95% CI, 0.16-0.91), and b) the intervention group had better medication adherence and lower incidence of hospitalizations and ED visits (IRR, 0.82; 95% CI, 0.73-0.93).
Conclusions:
The authors concluded that in this study, the estimated prevalence of inadequate health literacy was high, and inadequate health literacy was associated with increased risk of death and hospitalizations. These findings have important clinical and public health implications and warrant measurement of health literacy and deployment of interventions to improve outcomes.
Perspective:
This is an important study because it identifies important factors that are barriers to improving health care of HF patients. This study suggests that interventions to improve health literacy should improve outcomes in HF patients.
Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support
Keywords: Emergency Service, Hospital, Geriatrics, Health Literacy, Heart Failure, Heart-Assist Devices, Hospital Mortality, Hospitalization, Medication Adherence, Outcome Assessment, Health Care, Public Health, Risk Factors, Secondary Prevention
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