Cardiology: Low Health Literacy Tied to Heart Failure Mortality

Patients’ health literacy can be determined with three questions

A study published recently in the Journal of the American Medical Association found that patients with heart failure in an integrated managed care organization who had low health literacy were more likely to die than their peers with higher levels of health literacy. In the study, the authors used a unique three-question survey to determine patients’ levels of health literacy.

The Institute of Medicine defines health literacy as “the degree to which individuals can obtain, process and understand basic health information and services needed to make appropriate health decisions.” Much heart failure care falls onto the shoulders of patients, so an adequate level of health literacy is likely crucial in self-management and compliance, write the authors. However, little is known about the influence of health literacy and outcomes in heart failure patients. With the current study, the authors sought to evaluate the association between low health literacy and all-cause mortality and hospitalization among a population of outpatients with heart failure. They used three brief screening questions that can be easily incorporated into clinical practice.

This retrospective cohort analysis was conducted at Kaiser Permanente Colorado. A total of 1,494 outpatients with heart failure were identified between January 2001 and May 2008, surveyed by mail, and followed for a median of 1.2 years. Based on responses to three established screening questions, health literacy was assessed and determined to be either adequate or low. The questions were:

1. How often do you have someone help you read hospital materials?
2. How often do you have problems learning about your medical condition because of difficulty reading hospital materials?
3. How confident are you filling out forms by yourself?

The researchers found that 262 (17.5 percent) participants had low health literacy. Patients with low health literacy tended to be older, of lower socioeconomic status, less likely to have at least a high school education, and had higher rates of coexisting illnesses. Low health literacy was independently associated with higher mortality (17.6 percent compared to 6.3 percent) for those with adequate health literacy, but not hospitalization.

The authors write that the current study is the first to their knowledge to evaluate health literacy and outcomes among heart failure patients using brief screening questions. Existing studies, they note, have used more complex, interviewer-administered instruments to measure health literacy that are impractical for use in busy clinical settings. The authors conclude that, “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.”

Source: Peterson PN, Shetterly SM, Clarke, CL, et al. 2011. Health literacy and outcomes among patients with heart failure. Journal of the American Medical Association 305(16):1695-1701.