Low Health Literacy Associated With Higher Rate of
Death Among Heart Failure Patients
Low health literacy
patients were older, of lower socioeconomic status and less likely to
have a high school education; also more likely to have multiple chronic
diseases - watch video
April 26, 2011 An examination of health literacy - such as
understanding basic health information - among managed care patients
with heart failure, a condition that requires self-management, found
that nearly one in five have low health literacy, which was associated
with a higher all-cause risk of death, according to a study in the April
27 issue of the Journal of the American Medical Association (JAMA).
Health literacy is the degree to which individuals can obtain, process
and understand basic health information and services needed to make
appropriate health decisions, as defined by the Institute of Medicine.
Many U.S. citizens and as many as 1 in 3 Medicare enrollees have low
health literacy. Heart failure is a common and complex chronic disease
with a high risk of illness and death, according to the article.
"Although patients with heart failure are frequently hospitalized, much
care for heart failure is performed on a daily basis by individual
patients outside of the hospital," the authors write.
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."
Pamela N. Peterson, M.D., M.S.P.H., of the Denver Health Medical Center,
Denver, and colleagues evaluated the association between low health
literacy and all-cause mortality and hospitalization among a population
of outpatients with heart failure.
Senior citizens (65+) scored far lower than
younger people in a 2003 literacy test. The test had a maximum
score of 500.
study included patients of an integrated managed care organization with
heart failure who were identified between January 2001 and May 2008.
They 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 categorized 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.
the 2,156 patients surveyed, 1,547 responded (72 percent response rate).
Of 1,494 included responders, 262 (17.5 percent) 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
percent) in the low health literacy group and 78 (6.3 percent) in the
adequate health literacy group.
There were a total of 366 hospitalizations during follow-up, with 80
hospitalizations (30.5 percent) in the low health literacy group and 286
(23.2 percent) in the adequate health literacy group.
After adjusting for demographic variables, socioeconomic status,
education, comorbid conditions, year of cohort entry, and left
ventricular ejection fraction (a measure of how well the left ventricle
of the heart pumps with each contraction), low health literacy was
independently associated with an increased risk of mortality.
understanding 'medical speak' found in one-third
Feb. 12, 2007 To get
well, you need to follow the doctor's orders.
But, to follow the doctor's orders, you have to
understand them. Senior citizens are the most
likely not to understand medical instructions.
Many other Americans, too, suffer from low
health literacy, or difficulty understanding
"medical speak." This is a problem affecting
more than one-third of patients in the U.S.
health care system. View this video to learn
Click here to watch video.
adjusted models, low health literacy was not significantly associated
with all-cause hospitalization.
authors suggest that routine assessment of health literacy may help to
identify a greater number of patients at risk for adverse outcomes.
conclusion, this study demonstrates that even among those with health
insurance and access to health information, low health literacy as
assessed by 3 brief screening questions is associated with higher
mortality. This finding supports efforts to determine whether
interventions to screen for and address low health literacy can improve
important health outcomes in patients with heart failure," the
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