Low health literacy associated with increased risk of death in acute HF patients

Patients with acute heart failure had an increased risk of all-cause mortality after being discharged from the hospital if they had a low level of health literacy, according to a retrospective study.

After adjusting for various factors, the risk of death for patients with low health literacy was 32 percent higher than for patients with higher health literacy.

Lead researcher Candace D. McNaughton, MD, MPH, of the Department of Emergency Medicine at Vanderbilt University in Nashville, Tenn., and colleagues published their findings online in the Journal of the American Heart Association on April 29.

Nearly 6 million people in the U.S. have heart failure, and the disease is associated with direct medical costs of more than $21 billion, according to the researchers. Previous studies showed that patients hospitalized for acute heart failure are three times more likely to die compared with patients treated in an outpatient setting.

This study analyzed 1,379 patients who were discharged from the hospital after being admitted for acute heart failure between Nov. 1, 2010 and June 30, 2013. Patients were 18 years or older, had their race and gender available in the EHR and had three Brief Health Literacy Screen (BHLS) items recorded when they were hospitalized.

The BHLS measured health literacy and consisted of three items, each with a five-point scale. The three questions asked were:

  • How often do you have problems learning about your medical condition because of difficulty understanding written information?
  • How confident are you filling out medical forms by yourself?
  • How often do you have someone (like a family member, friend, hospital/clinic worker, or caregiver) help you read hospital materials?

The researchers found 23.5 percent of patients had a low health literacy, which was defined as a BHLS score of nine or lower. Patients with low health literacy were older, stayed in the hospital longer and were less likely to have private health insurance coverage.

In addition, 38.3 percent of patients with low health literacy died compared with 26.5 percent of patients with higher BHLS scores. The median time to death was shorter in the low health literacy group, as well.