Heart failure: Poor health literacy raises risk of death

A review of research has found that the ability to obtain and understand basic health information and services partly determines the mortality rate of people with heart failure.

Older adult talking to doctor
A recent study looks at links between health literacy and health outcomes.

Heart failure impairs the capacity of the heart to pump blood around the body. This can cause shortness of breath, fatigue, and swelling of the ankles, feet, legs, and abdomen.

About 5.7 million people in the United States are living with heart failure, according to the National Heart, Lung, and Blood Institute.

There is no cure for heart failure, but medication and lifestyle changes can help people with the condition to live longer, more active lives.

Among the medicines that doctors commonly prescribe are drugs to lower blood pressure, reduce fluid buildup, and treat underlying health conditions such as diabetes.

Doctors may ask people experiencing heart failure to quit smoking and reduce their alcohol consumption. They may ask them to monitor their blood pressure, weight, blood sugar levels, improve their diet, and follow an exercise program.

The success of complex drug regimens and lifestyle recommendations relies upon a person’s ability to manage their condition. But studies investigating the importance of peoples’ health literacy have given inconsistent results.

A review and meta-analysis of previous research now suggests that health literacy plays a significant role in determining the outlook for people with heart failure.

Basic health information

The authors define health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

The review, led by Dr. Matteo Fabbri, appears in the journal JACC: Heart Failure.

In their review, they included 11 observational studies of a total of 9,171 patients with heart failure. Standard assessment tools rated 2,207 (24%) of them as having “inadequate” or “marginal” health literacy.

The researchers discovered that inadequate health literacy ad associations with a 67% increased risk of mortality, a 17% increase in visits to emergency departments, and a 19% increased risk of hospitalization.

After adjusting for other potential contributory factors, such as other illnesses, age, sex, and education level, the associations remained statistically significant for hospitalization and mortality, but not for emergency department visits.

After adjustments, there was a 41% increase in mortality and a 12% increase in hospitalizations among patients with poor health literacy.

The scientists also reviewed evidence from four studies that measured the success of educational interventions to improve patients’ health literacy. Of these, two demonstrated improved health outcomes.

The effective educational interventions focused on self-care, such as weight management, recognizing symptoms, and medication management.

“Our findings showed that an inadequate level of health literacy is associated with increased risks in mortality and hospitalization among patients with heart failure,” says Lila J. Finney Rutten, Ph.D., professor of health services research at the Mayo Clinic in Rochester, Minnesota, and one of the authors.

“Identifying health literacy as a factor that affects health outcomes and measuring its effect on patients with heart failure is essential to allocate more resources for and research on interventions to improve health literacy,” she added.

Complex connection

The authors write that the connection between inadequate health literacy and poor outcomes in heart failure is likely to be complex.

Some of the studies they reviewed suggest that people with inadequate health literacy are less likely to access health care services. When they do, they are less likely to communicate effectively with physicians.

For example, they may be less likely to seek clarifications, they write, perhaps due to feelings of shame about their lack of health-related knowledge.

The authors note: “These missed opportunities to seek clarifications are even more critical when considering that educational materials provided often exceed the reading ability of a patient with inadequate health literacy.

All of these barriers may explain why these patients are less likely to engage in efficient self-care management and, ultimately, are more likely to experience adverse outcomes.”

“Given the staggering mortality and hospitalization burden in [heart failure], it is essential to pursue any opportunity to improve outcomes, underscoring the crucial importance of health literacy among patients with [heart failure].”

– Matteo Fabbri et al.

The researchers acknowledge that their analysis has some limitations. For example, the studies reviewed used different tools to assess health literacy.

Some of the assessment tools were subjective, measuring how much patients think they understand, whereas others were objective, directly evaluating their comprehension of medical information.

When the authors analyzed the two types of study separately, however, they got similar results for each.

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