CONTEXT: Little is known about the effects of low health literacy among patients with heart failure, a condition that requires self-management and frequent interactions with the health care system. OBJECTIVE: To evaluate the association between low health literacy and all-cause mortality and hospitalization among outpatients with heart failure. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study conducted at Kaiser Permanente Colorado, an integrated managed care organization. Outpatients with heart failure were identified between January 2001 and May 2008, were surveyed by mail, and underwent follow-up for a median of 1.2 years. Health literacy was assessed using 3 established screening questions and categorized as adequate or low. Responders were excluded if they did not complete at least 1 health literacy question or if they did not have at least 1 year of enrollment prior to the survey date. MAIN OUTCOME MEASURES: All-cause mortality and all-cause hospitalization. RESULTS: Of the 2156 patients surveyed, 1547 responded (72% response rate). Of 1494 included responders, 262 (17.5%) had low health literacy. Patients with low health literacy were older, of lower socioeconomic status, less likely to have at least a high school education, and had higher rates of coexisting illnesses. In multivariable Cox regression, low health literacy was independently associated with higher mortality (unadjusted rate, 17.6% vs 6.3%; adjusted hazard ratio, 1.97 [95% confidence interval, 1.3-2.97]; P = .001) but not hospitalization (unadjusted rate, 30.5% vs 23.2%; adjusted hazard ratio, 1.05 [95% confidence interval, 0.8-1.37]; P = .73). CONCLUSION: Among patients with heart failure in an integrated managed care organization, low health literacy was significantly associated with higher all-cause mortality.
CONTEXT: Little is known about the effects of low health literacy among patients with heart failure, a condition that requires self-management and frequent interactions with the health care system. OBJECTIVE: To evaluate the association between low health literacy and all-cause mortality and hospitalization among outpatients with heart failure. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study conducted at Kaiser Permanente Colorado, an integrated managed care organization. Outpatients with heart failure were identified between January 2001 and May 2008, were surveyed by mail, and underwent follow-up for a median of 1.2 years. Health literacy was assessed using 3 established screening questions and categorized as adequate or low. Responders were excluded if they did not complete at least 1 health literacy question or if they did not have at least 1 year of enrollment prior to the survey date. MAIN OUTCOME MEASURES: All-cause mortality and all-cause hospitalization. RESULTS: Of the 2156 patients surveyed, 1547 responded (72% response rate). Of 1494 included responders, 262 (17.5%) had low health literacy. Patients with low health literacy were older, of lower socioeconomic status, less likely to have at least a high school education, and had higher rates of coexisting illnesses. In multivariable Cox regression, low health literacy was independently associated with higher mortality (unadjusted rate, 17.6% vs 6.3%; adjusted hazard ratio, 1.97 [95% confidence interval, 1.3-2.97]; P = .001) but not hospitalization (unadjusted rate, 30.5% vs 23.2%; adjusted hazard ratio, 1.05 [95% confidence interval, 0.8-1.37]; P = .73). CONCLUSION: Among patients with heart failure in an integrated managed care organization, low health literacy was significantly associated with higher all-cause mortality.
Authors: Alan S Go; Jingrong Yang; Lynn M Ackerson; Krista Lepper; Sean Robbins; Barry M Massie; Michael G Shlipak Journal: Circulation Date: 2006-06-05 Impact factor: 29.690
Authors: Darren A Dewalt; Nancy D Berkman; Stacey Sheridan; Kathleen N Lohr; Michael P Pignone Journal: J Gen Intern Med Date: 2004-12 Impact factor: 5.128
Authors: Barbara Riegel; Debra K Moser; Stefan D Anker; Lawrence J Appel; Sandra B Dunbar; Kathleen L Grady; Michelle Z Gurvitz; Edward P Havranek; Christopher S Lee; Joann Lindenfeld; Pamela N Peterson; Susan J Pressler; Douglas D Schocken; David J Whellan Journal: Circulation Date: 2009-08-31 Impact factor: 29.690
Authors: J A Gazmararian; D W Baker; M V Williams; R M Parker; T L Scott; D C Green; S N Fehrenbach; J Ren; J P Koplan Journal: JAMA Date: 1999-02-10 Impact factor: 56.272
Authors: Lorraine S Evangelista; Kismet D Rasmusson; Ann S Laramee; Joan Barr; Susan E Ammon; Sandra Dunbar; Susan Ziesche; J Herbert Patterson; Clyde W Yancy Journal: J Card Fail Date: 2009-12-11 Impact factor: 5.712
Authors: Lisa D Chew; Joan M Griffin; Melissa R Partin; Siamak Noorbaloochi; Joseph P Grill; Annamay Snyder; Katharine A Bradley; Sean M Nugent; Alisha D Baines; Michelle Vanryn Journal: J Gen Intern Med Date: 2008-03-12 Impact factor: 5.128
Authors: Kerri Cavanaugh; Kenneth A Wallston; Tebeb Gebretsadik; Ayumi Shintani; Mary Margaret Huizinga; Dianne Davis; Rebecca Pratt Gregory; Robb Malone; Michael Pignone; Darren DeWalt; Tom A Elasy; Russell L Rothman Journal: Diabetes Care Date: 2009-09-09 Impact factor: 19.112
Authors: Diana W Stewart; Lorraine R Reitzel; Virmarie Correa-Fernández; Miguel Ángel Cano; Claire E Adams; Yumei Cao; Yisheng Li; Andrew J Waters; David W Wetter; Jennifer Irvin Vidrine Journal: J Behav Med Date: 2014-04-08
Authors: Matteo Fabbri; Kathleen Yost; Lila J Finney Rutten; Sheila M Manemann; Cynthia M Boyd; Daniel Jensen; Susan A Weston; Ruoxiang Jiang; Véronique L Roger Journal: Mayo Clin Proc Date: 2017-12-06 Impact factor: 7.616
Authors: Carlos J Rodriguez; Matthew Allison; Martha L Daviglus; Carmen R Isasi; Colleen Keller; Enrique C Leira; Latha Palaniappan; Ileana L Piña; Sarah M Ramirez; Beatriz Rodriguez; Mario Sims Journal: Circulation Date: 2014-07-14 Impact factor: 29.690
Authors: Kristen R Scarpato; Stephen F Kappa; Kathryn M Goggins; Sam S Chang; Joseph A Smith; Peter E Clark; David F Penson; Matthew J Resnick; Daniel A Barocas; Kamran Idrees; Sunil Kripalani; Kelvin A Moses Journal: J Health Commun Date: 2016-09-23
Authors: Misty A W Hawkins; Mary A Dolansky; Jennifer B Levin; Julie T Schaefer; John Gunstad; Joseph D Redle; Richard Josephson; Joel W Hughes Journal: Heart Lung Date: 2016 Sep-Oct Impact factor: 2.210
Authors: Sandra B Dunbar; Brittany Butts; Carolyn M Reilly; Rebecca A Gary; Melinda K Higgins; Erin P Ferranti; Steven D Culler; Javed Butler Journal: Nurs Outlook Date: 2013-10-02 Impact factor: 3.250
Authors: Candace D McNaughton; Sunil Kripalani; Courtney Cawthon; Lorraine C Mion; Kenneth A Wallston; Christianne L Roumie Journal: Med Care Date: 2014-04 Impact factor: 2.983