BACKGROUND: Low literacy increases 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 II-IV within the past 6 months) who were enrolled in a randomized controlled trial of self-care training recruited from internal medicine and cardiology clinics at four academic medical centers in the US. The primary outcome was combined all-cause hospitalization or death, with a secondary outcome of hospitalization for HF. 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. We used negative binomial regression to examine whether the incidence of the primary and secondary outcomes differed according to literacy. RESULTS: Of the 595 study participants, 37 % had low literacy. Mean age was 61, 31 % were NYHA class III/IV at baseline, 16 % were Latino, and 38 % were African-American. Those with low literacy were older, had a higher NYHA class, and were more likely to be Latino (all p < 0.001). Adjusting for site only, participants with low literacy had an incidence rate ratio (IRR) of 1.39 (95 % CI: 0.99, 1.94) for all-cause hospitalization or death and 1.36 (1.11, 1.66) for HF-related hospitalization. After adjusting for demographic, clinical, and self-management factors, the IRRs were 1.31 (1.06, 1.63) for all-cause hospitalization and death and 1.46 (1.20, 1.78) for HF-related hospitalization. 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.
RCT Entities:
BACKGROUND: Low literacy increases 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 II-IV within the past 6 months) who were enrolled in a randomized controlled trial of self-care training recruited from internal medicine and cardiology clinics at four academic medical centers in the US. The primary outcome was combined all-cause hospitalization or death, with a secondary outcome of hospitalization for HF. 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. We used negative binomial regression to examine whether the incidence of the primary and secondary outcomes differed according to literacy. RESULTS: Of the 595 study participants, 37 % had low literacy. Mean age was 61, 31 % were NYHA class III/IV at baseline, 16 % were Latino, and 38 % were African-American. Those with low literacy were older, had a higher NYHA class, and were more likely to be Latino (all p < 0.001). Adjusting for site only, participants with low literacy had an incidence rate ratio (IRR) of 1.39 (95 % CI: 0.99, 1.94) for all-cause hospitalization or death and 1.36 (1.11, 1.66) for HF-related hospitalization. After adjusting for demographic, clinical, and self-management factors, the IRRs were 1.31 (1.06, 1.63) for all-cause hospitalization and death and 1.46 (1.20, 1.78) for HF-related hospitalization. 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.
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: Cornelia H M van Jaarsveld; Adelita V Ranchor; Gertrudis I J M Kempen; James C Coyne; Dirk J van Veldhuisen; Robbert Sanderman Journal: Eur J Heart Fail Date: 2005-10-04 Impact factor: 15.534
Authors: Ronald T Ackermann; Marc B Rosenman; Stephen M Downs; Ann M Holmes; Barry P Katz; Jingjin Li; Alan J Zillich; Caroline P Carney; Thomas S Inui Journal: Gen Hosp Psychiatry Date: 2005 Sep-Oct Impact factor: 3.238
Authors: L Michael Prisant; Kevin L Thomas; Eldrin F Lewis; Zhen Huang; Gary S Francis; W Douglas Weaver; Marc A Pfeffer; John J V McMurray; Robert M Califf; Eric J Velazquez Journal: J Am Coll Cardiol Date: 2008-05-13 Impact factor: 24.094
Authors: Michael D Murray; James Young; Shawn Hoke; Wanzhu Tu; Michael Weiner; Daniel Morrow; Kevin T Stroupe; Jingwei Wu; Daniel Clark; Faye Smith; Irmina Gradus-Pizlo; Morris Weinberger; D Craig Brater Journal: Ann Intern Med Date: 2007-05-15 Impact factor: 25.391
Authors: Darren A DeWalt; Robert M Malone; Mary E Bryant; Margaret C Kosnar; Kelly E Corr; Russell L Rothman; Carla A Sueta; Michael P Pignone Journal: BMC Health Serv Res Date: 2006-03-13 Impact factor: 2.655
Authors: Gregory J Fermann; Phillip D Levy; Peter Pang; Javed Butler; S Imran Ayaz; Douglas Char; Patrick Dunn; Cathy A Jenkins; Christy Kampe; Yosef Khan; Vijaya A Kumar; JoAnn Lindenfeld; Dandan Liu; Karen Miller; W Frank Peacock; Samaa Rizk; Chad Robichaux; Russell L Rothman; Jon Schrock; Adam Singer; Sarah A Sterling; Alan B Storrow; Cheryl Walsh; John Wilburn; Sean P Collins Journal: Circ Heart Fail Date: 2017-02 Impact factor: 8.790
Authors: Jia-Rong Wu; Barbara Mark; George J Knafl; Sandra B Dunbar; Patricia P Chang; Darren A DeWalt Journal: Heart Lung Date: 2019-06-07 Impact factor: 2.210
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: 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
Authors: Nwamaka D Eneanya; Michael Winter; Howard Cabral; Katherine Waite; Lori Henault; Timothy Bickmore; Amresh Hanchate; Michael Wolf; Michael K Paasche-Orlow Journal: J Health Care Poor Underserved Date: 2016