title: Health Literacy Predicts Morbidity and Mortality in Rural Patients With Heart Failure.
abstract: BACKGROUND
  Patients hospitalized with heart failure are often readmitted. Health literacy may play a substantial role in the high rate of readmissions. The purpose of this study was to examine the association of health literacy with the composite end point of heart failure readmission rates and all-cause mortality in patients with heart failure living in rural areas.
  
  
  RESULTS
  Rural adults (n = 575), hospitalized for heart failure within the past 6 months, completed the Short Test of Functional Health Literacy in Adults (STOFHLA) to measure health literacy and were followed for ≥2 years. The percentage of patients with the end point of heart failure readmission or all-cause death was different (P = .001) among the 3 STOFHLA score levels. Unadjusted analysis revealed that patients with inadequate and marginal health literacy were 1.94 (95% confidence interval [CI] 1.43-2.63; P < .001) times, and 1.91 (95% CI 1.36-2.67; P < .001) times, respectively, more likely to experience the outcome. After adjustment for covariates, health literacy remained a predictor of outcomes. Of the other covariates, worse functional class, higher comorbidity burden, and higher depression score predicted worse outcomes.
  
  
  CONCLUSIONS
  Inadequate or marginal health literacy is a risk factor for heart failure rehospitalization or all-cause mortality among rural patients with heart failure.
authors.affiliation: College of Nursing, University of Kentucky, Lexington, Kentucky. Electronic address: dmoser@uky.edu.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.affiliation: University of California, San Francisco, California.
authors.forename: Susan
authors.initials: S
authors.lastname: Robinson
authors.affiliation: College of Nursing, University of Kentucky, Lexington, Kentucky.
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Biddle
authors.affiliation: University of Reno, Reno, Nevada.
authors.forename: Michele M
authors.initials: MM
authors.lastname: Pelter
authors.affiliation: University of California, Davis, California.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Nesbitt
authors.affiliation: University of California, Davis, California.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Southard
authors.affiliation: National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Lawton
authors.initials: L
authors.lastname: Cooper
authors.affiliation: University of California, San Francisco, California.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dracup
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D057220:Health Literacy / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D015996:Survival Rate
keywords: Health literacy; heart failure; rural