Impact of Health Literacy on Long-Term Outcomes in Patients with Heart Failure

Introduction: Health literacy (HL) is an important concept for patient education and disease management of heart failure (HF). It has been demonstrated that HL is associated with clinical outcomes including death and readmission. Although previous research on HL has predominantly focused on functional HL (the ability to “read and write”), the World Health Organization advocates evaluation of comprehensive HL, including the ability to access information (communicative HL) and critically evaluate information (critical HL). However, the impact of these three HL components on long-term adverse outcomes in patients with HF has never been fully investigated. Methods: We conducted a prospective observational study to examine the associations between HL level and risk of death or readmission in 234 patients (mean age, 67.8 years; male, 62%). HL, including subscales of functional, communicative, and critical HL, was assessed using the HF specific HL scale, which has been reported to be valid and reliable in patients with HF. Sociodemographic, clinical, and depressive symptoms were also assessed. Mortality and hospitalization data were obtained during a 2 year follow-up (median duration, 707 days). Results: Among all patients, 19.7% exhibited a low HL score. In each subscale, 19.7%, 23.1%, and 23.9% of patients exhibited low functional, low communicative, and low critical HL, respectively. Patients with low HL were older and living alone. In multivariate Cox regression, low critical HL was independently associated with higher readmission exacerbated HF after controlling for demographic and clinical characteristics, HF severity, depressive symptoms at baseline (unadjusted rate, 23.2% vs. 9.1%; adjusted hazard ratio, 3.89 [95% CI, 1.24–12.21]; P=0.02). However, there was no association between all types of HL and mortality, and between functional and communicative HL and readmission due to HF. Conclusions: Critical HL is an independent risk factor for HF readmission in patients with HF. To improve clinical outcomes in patients with HF, effective interventions should be developed to improve patient skills for critically analyzing information and making decisions.