Health Literacy and Outcomes in Patients With Heart Failure: A Prospective Community Study

Matteo Fabbri, Kathleen Yost, Lila J. Finney Rutten, Sheila M. Manemann, Cynthia Boyd, Daniel Jensen, Susan A. Weston, Ruoxiang Jiang, Véronique L. Roger

Research output: Contribution to journalArticle

Abstract

Objective: To examine the impact of health literacy on hospitalizations and death in a population of patients with heart failure (HF). Patients and Methods: Residents from the 11-county region in southeast Minnesota with a first-ever International Classification of Diseases, Ninth Revision code 428 or Tenth Revision code 150 (n=5121) from January 1, 2013, through December 31, 2015, were identified and prospectively surveyed to measure health literacy using established screening questions. A total of 2647 patients returned the survey (response rate, 52%); 2487 patients with complete health literacy data were retained for analysis. Health literacy, measured as a composite score on three 5-point scales, was categorized as adequate (≥8) or low (<8). Cox proportional hazards regression and Andersen-Gill models were used to examine the association of health literacy with mortality and hospitalization. Results: Of 2487 patients (mean age, 73.5 years; 53.6% male [n=1333]), 10.5% (n= 261) had low health literacy. After mean ± SD follow-up of 15.5±7.2 months, 250 deaths and 1584 hospitalizations occurred. Low health literacy was associated with increased mortality and hospitalizations. After adjusting for age, sex, comorbidity, education, and marital status, the hazard ratios for death and hospitalizations in patients with low health literacy were 1.91 (95% CI, 1.38-2.65; P<.001) and 1.30 (95% CI, 1.02-1.66; P=.03), respectively, compared with patients with adequate health literacy. Conclusion: Low health literacy is associated with increased risks of hospitalization and death in patients with HF. The clinical evaluation of health literacy could help design interventions individualized for patients with low health literacy.

Original languageEnglish (US)
JournalMayo Clinic Proceedings
DOIs
StateAccepted/In press - Jan 1 2017

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Health Literacy
Heart Failure
Prospective Studies
Hospitalization
Sex Education
Mortality
Marital Status
International Classification of Diseases
Comorbidity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Fabbri, M., Yost, K., Finney Rutten, L. J., Manemann, S. M., Boyd, C., Jensen, D., ... Roger, V. L. (Accepted/In press). Health Literacy and Outcomes in Patients With Heart Failure: A Prospective Community Study. Mayo Clinic Proceedings. https://doi.org/10.1016/j.mayocp.2017.09.018

Health Literacy and Outcomes in Patients With Heart Failure : A Prospective Community Study. / Fabbri, Matteo; Yost, Kathleen; Finney Rutten, Lila J.; Manemann, Sheila M.; Boyd, Cynthia; Jensen, Daniel; Weston, Susan A.; Jiang, Ruoxiang; Roger, Véronique L.

In: Mayo Clinic Proceedings, 01.01.2017.

Research output: Contribution to journalArticle

Fabbri, Matteo ; Yost, Kathleen ; Finney Rutten, Lila J. ; Manemann, Sheila M. ; Boyd, Cynthia ; Jensen, Daniel ; Weston, Susan A. ; Jiang, Ruoxiang ; Roger, Véronique L. / Health Literacy and Outcomes in Patients With Heart Failure : A Prospective Community Study. In: Mayo Clinic Proceedings. 2017.
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abstract = "Objective: To examine the impact of health literacy on hospitalizations and death in a population of patients with heart failure (HF). Patients and Methods: Residents from the 11-county region in southeast Minnesota with a first-ever International Classification of Diseases, Ninth Revision code 428 or Tenth Revision code 150 (n=5121) from January 1, 2013, through December 31, 2015, were identified and prospectively surveyed to measure health literacy using established screening questions. A total of 2647 patients returned the survey (response rate, 52{\%}); 2487 patients with complete health literacy data were retained for analysis. Health literacy, measured as a composite score on three 5-point scales, was categorized as adequate (≥8) or low (<8). Cox proportional hazards regression and Andersen-Gill models were used to examine the association of health literacy with mortality and hospitalization. Results: Of 2487 patients (mean age, 73.5 years; 53.6{\%} male [n=1333]), 10.5{\%} (n= 261) had low health literacy. After mean ± SD follow-up of 15.5±7.2 months, 250 deaths and 1584 hospitalizations occurred. Low health literacy was associated with increased mortality and hospitalizations. After adjusting for age, sex, comorbidity, education, and marital status, the hazard ratios for death and hospitalizations in patients with low health literacy were 1.91 (95{\%} CI, 1.38-2.65; P<.001) and 1.30 (95{\%} CI, 1.02-1.66; P=.03), respectively, compared with patients with adequate health literacy. Conclusion: Low health literacy is associated with increased risks of hospitalization and death in patients with HF. The clinical evaluation of health literacy could help design interventions individualized for patients with low health literacy.",
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AB - Objective: To examine the impact of health literacy on hospitalizations and death in a population of patients with heart failure (HF). Patients and Methods: Residents from the 11-county region in southeast Minnesota with a first-ever International Classification of Diseases, Ninth Revision code 428 or Tenth Revision code 150 (n=5121) from January 1, 2013, through December 31, 2015, were identified and prospectively surveyed to measure health literacy using established screening questions. A total of 2647 patients returned the survey (response rate, 52%); 2487 patients with complete health literacy data were retained for analysis. Health literacy, measured as a composite score on three 5-point scales, was categorized as adequate (≥8) or low (<8). Cox proportional hazards regression and Andersen-Gill models were used to examine the association of health literacy with mortality and hospitalization. Results: Of 2487 patients (mean age, 73.5 years; 53.6% male [n=1333]), 10.5% (n= 261) had low health literacy. After mean ± SD follow-up of 15.5±7.2 months, 250 deaths and 1584 hospitalizations occurred. Low health literacy was associated with increased mortality and hospitalizations. After adjusting for age, sex, comorbidity, education, and marital status, the hazard ratios for death and hospitalizations in patients with low health literacy were 1.91 (95% CI, 1.38-2.65; P<.001) and 1.30 (95% CI, 1.02-1.66; P=.03), respectively, compared with patients with adequate health literacy. Conclusion: Low health literacy is associated with increased risks of hospitalization and death in patients with HF. The clinical evaluation of health literacy could help design interventions individualized for patients with low health literacy.

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