Abstract 21224: Health Literacy in Outpatients with Heart Failure: Determinants and Association with Outcomes
Introduction: Health literacy is central to patients' participation in their care and is important for control of chronic conditions like heart failure (HF). The Rapid Estimates of Adults Literacy in Medicine (REALM) is an easy to perform test that describes the patient's ability to read health-related terminology. Data regarding health literacy and its association with outcomes in patients with HF are limited.
Methods: Health literacy was evaluated with the REALM score in 154 HF outpatients at enrollment in a prospective study in the greater metropolitan Atlanta, GA area from 1/2008 to 7/2009. We examined (1) correlates of REALM score among sociodemographic variables and (2) the association of REALM score with HF outcomes, including (1) hard events (death, urgent cardiac transplantation, or ventricular assist device implantation) and (2) all-cause hospital admission rates.
Results: Mean age of patients was 57.4±12.1 years; 62.5% were male; 56.7% were white and 39.5% black; 47.9% had annual family income <$50,000; and 60.5% had less than college-level education. Among the 154 patients, 30 (19.5%) had low or marginal REALM score (≤60) and 124 (80.5%) had adequate REALM score (>60). Annual family income (<$50,000 vs. ≥$50,000: OR, 10.5; 95% CI, 2.93–37.8; p<0.001), race (black vs. white: OR, 5.64, 95% CI, 2.30–13.8; p<0.001), and education level (college or higher vs. less than college-level education: OR, 5.52, 95% CI, 1.82–16.8; p=0.003), were strongly associated with REALM score ≤60. Gender was not associated with REALM score. Over 16±6 months of follow-up of (total: 204 person-years), there were 8 (5.2%) hard events and 128 all-cause admissions (62.6 per 100 person-years). REALM score was not associated with hard events. However, patients with REALM score ≤60 experienced 35 admissions over 40 person-years (rate: 87.5 per 100 person-years), whereas patients with REALM score >60 experienced 93 admissions over 164 person-years (rate: 45.5 per 100 person-years). REALM score ≤60 was associated with 55% higher rate of admissions (95% CI, 4% to 127% p=0.033) in Poisson models.
Conclusions: Suboptimal health literacy is driven by low socioeconomic status, is more frequent among blacks, and is associated with increased admission rates in patients with HF.
- © 2010 by American Heart Association, Inc.