Abstract 3147: Low Health Literacy is Associated With Increased Risk of Mortality in Patients With Heart Failure
Background: Low health literacy predicts mortality among relatively healthy older patients. However, little is known about the prevalence or effect of low health literacy among patients with chronic diseases that require self-management and frequent interactions with the healthcare system such as heart failure (HF). Our objective was to evaluate the association between health literacy and mortality among patients with HF.
Methods: We surveyed 1554 ambulatory members of Kaiser Permanente, Colorado with a prior hospitalization with a primary discharge diagnosis of HF between Jan, 2001 and Dec, 2007. Health literacy was assessed using three screening questions and categorized as adequate and low. Patients who did not answer at least one of the health literacy questions (n=40) or with less than one year enrollment (n=20) were excluded. The association between health literacy and mortality was evaluated using multivariable Cox regression adjusting for demographics, comorbidities, ejection fraction and education level.
Results: Of 1494 patients, 82.5% (n=1232) had adequate health literacy and 17.5% (n=262) had low health literacy. Over a median of 365 days, 124 deaths occurred. After adjustment, education level was not associated with mortality (HR 1.01; 95% CI 0.63–1.61); however, low health literacy was significantly associated with a higher risk of death (HR 1.82; 95% CI 1.21–2.74).
Conclusions: Low health literacy scores were prevalent and strongly associated with mortality in ambulatory patients with HF. This association was independent of self reported education level, highlighting the importance of assessing health specific literacy rather than using education level as a surrogate. As a potentially modifiable factor, future studies should evaluate whether interventions to identify and address low health literacy will improve outcomes.
This research has received full or partial funding support from the American Heart Association, National Center.