Author + information
- Received September 12, 2019
- Revision received November 4, 2019
- Accepted November 6, 2019
- Published online May 25, 2020.
- Matteo Fabbri, MDa,
- M. Hassan Murad, MD, MPHb,c,
- Alexandra M. Wennberg, PhDd,
- Pierpaolo Turcano, MDd,
- Patricia J. Erwin, MLSe,
- Fares Alahdab, MDb,c,
- Alvise Berti, MDf,
- Sheila M. Manemann, MPHa,
- Kathleen J. Yost, PhDa,b,
- Lila J. Finney Rutten, PhD, MPHa,b and
- Véronique L. Roger, MD, MPHa,g,∗ ()
- aDepartment of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- bRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- cMayo Clinic Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
- dDepartment of Neurology, Mayo Clinic, Rochester, Minnesota
- eMayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota
- fDepartment of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
- gDivision of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Véronique L. Roger, Mayo Clinic, 200 First Street, SW, Rochester, Minnesota 55905.
Objectives The purpose of this study was to determine if health literacy is associated with mortality, hospitalizations, or emergency department (ED) visits among patients living with heart failure (HF).
Background Growing evidence suggests an association between health literacy and health-related outcomes in patients with HF.
Methods We searched Embase, MEDLINE, PsycINFO, and EBSCO CINAHL from inception through January 1, 2019, with the help of a medical librarian. Eligible studies evaluated health literacy among patients with HF and assessed mortality, hospitalizations, and ED visits for all causes with no exclusion by time, geography, or language. Two reviewers independently selected studies, extracted data, and assessed the methodological quality of the identified studies.
Results We included 15 studies, 11 with an overall high methodological quality. Among the observational studies, an average of 24% of patients had inadequate or marginal health literacy. Inadequate health literacy was associated with higher unadjusted risk for mortality (risk ratio [RR]: 1.67; 95% confidence interval [CI]: 1.18 to 2.36), hospitalizations (RR: 1.19; 95% CI: 1.09 to 1.29), and ED visits (RR: 1.17; 95% CI: 1.03 to 1.32). When the adjusted measurements were combined, inadequate health literacy remained statistically associated with mortality (RR: 1.41; 95% CI: 1.06 to 1.88) and hospitalizations (RR: 1.12; 95% CI: 1.01 to 1.25). Among the 4 interventional studies, 2 effectively improved outcomes among patients with inadequate health literacy.
Conclusions In this study, the estimated prevalence of inadequate health literacy was high, and inadequate health literacy was associated with increased risk of death and hospitalizations. These findings have important clinical and public health implications and warrant measurement of health literacy and deployment of interventions to improve outcomes.
This publication was made possible by Clinical and Translational Science Awards grant number UL1 TR002377 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health (NIH), and the National Heart, Lung and Blood Institute (R01 HL120859). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. Dr. Finney Rutten serves as a consultant with Exact Sciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Heart Failure author instructions page.
- Received September 12, 2019.
- Revision received November 4, 2019.
- Accepted November 6, 2019.
- 2020 American College of Cardiology Foundation
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