Lower health literacy linked to higher mortality in acute decompensated HF

Poor health literacy could mean an increased risk of death for patients hospitalized with acute decompensated heart failure (ADHF), according to a study published in Mayo Clinic Proceedings Nov. 7.

Health literacy (HL), a knowledge base that’s formed early in life alongside traditional schooling, is a critical tool for CVD patients facing hospital discharge, corresponding author Lindsay S. Mayberry, MS, PhD, and colleagues with Vanderbilt University Medical Center, said in the journal. Being able to understand medical literature, manage new medications and perform self-care are prerequisites for a successful recovery.

“Despite emphasis on HL as an important determinant of mortality in adults with CVD, the mechanisms by which HL might lead to increased mortality are poorly understood,” Mayberry et al. wrote. “Research identifying modifiable targets linking low HL to poor outcomes is needed to inform interventions in adults with CVD.”

Previous studies have linked lower health literacy to elevated mortality in community-dwelling elders and adults with congestive heart failure, they said, but none have explored the impact HL can have on the management of acute coronary syndromes.

Mayberry and coauthors’ trial studied 2,977 patients discharged from Vanderbilt University Hospital between October 2011 and December 2015. According to the research, patients were on average 61 years old and white, and 37 percent were admitted with ADHF. Each patient participated in a bedside-administered survey and consented to health record review.

Considering mediators like social support, health competence, health behaviors, comorbidity index, type of CVD diagnosis and previous-year hospitalizations, the team found that between 17 and 23 percent of all study subjects had “inadequate” HL, depending on the measure studied. Ten percent of the pool died within a year.

Mayberry et al. said lower health literacy was independently associated with lower health competence, worse health behaviors, poorer social support and more previous hospitalizations. That translated to a significant increase in patients’ likelihood of one-year mortality—each standard deviation decrease in HL was associated with an absolute 3.2 percent increase in probability of death.

The team said the relationship between HL and mortality appears to be driven by mediators and might be improved with interventions like health coaching or cardiac rehabilitation. Those options, with a handful of others like dietary changes and exercise programs, can improve perceived health competence and health behaviors, raising an individual’s HL.

“These findings suggest that patients screened to have low HL while hospitalized with CVD should further be assessed for perceived health competence and health behaviors to inform delivery of appropriate targeted interventions, based on patients’ specific health behaviors and requisites for management of their cardiovascular condition,” the authors wrote. “Identification of adults with limited HL or low perceived health competence can be a first step to providing tailored interventions targeting these modifiable constructs to prevent poor outcomes, although future research studies with such interventions would be needed for confirmation.”