Abstract 10526: Low Literacy is Associated with Increased Risk of Hospitalization and Death Among Individuals with Heart Failure
Background: Low literacy skills increase the risk for many adverse health outcomes, but the relationship between literacy and adverse outcomes in heart failure (HF) has not been well studied.
Methods: We studied a cohort of ambulatory patients with symptomatic HF (NYHA Class 2 or greater symptoms within the past 6 months) who were enrolled in a randomized clinical trial of self-care training recruited from internal medicine and cardiology clinics at 4 academic medical centers. The primary outcome was combined all-cause hospitalization or death, with a secondary outcome of hospitalization for heart failure. Outcomes were assessed through blinded interviews and subsequent chart reviews, with adjudication of cause by a panel of masked assessors. Literacy was measured using the short Test of Functional Health Literacy in Adults, with inadequate and marginal scores defined as low literacy. We used negative binomial regression to examine whether the incidence of the primary and secondary outcomes differed according to literacy, controlling for site. Further adjustment for demographic (age, race/ethnicity, and gender) and clinical (HF-related quality of life, systolic disfunction, hypertension, history of CVD, use of beta-blocker) was also performed.
Results: Total of 605 participants were enrolled; 37% had low literacy. Mean age was 60.7, 31 percent were NYHA class III/IV at baseline, 16 percent were Latino, and 38 percent were African-American. Those with low literacy were older, had higher NYHA class, and were more likely to be Latino (all p<.001). There were 447 primary events; individuals with low literacy had a higher annual rate (183 events, 0.83/person-year) than those with adequate literacy (264 events, rate of 0.71/person-year). Individuals with low literacy had an incidence rate ratio (IRR) of 1.43 (95% CI: 1.001, 2.05) for all-cause hospitalization or death and 1.42 (1.11, 1.83) for heart failure hospitalization. Adjusted IRRs for all-cause hospitalization and death were 1.27 (1.04, 1.54) and for HF-related hospitalizations 1.26 (1.15, 1.37).
Conclusions: Low literacy increased the risk of hospitalization for ambulatory patients with heart failure. Interventions designed to mitigate literacy-related disparities in outcomes are warranted
- © 2011 by American Heart Association, Inc.