Health literacy and mortality: a cohort study of patients hospitalized for acute heart failure.
BACKGROUND
More than 30% of patients hospitalized for heart failure are rehospitalized or die within 90 days of discharge. Lower health literacy is associated with mortality among outpatients with chronic heart failure; little is known about this relationship after hospitalization for acute heart failure.


RESULTS
Patients hospitalized for acute heart failure and discharged home between November 2010 and June 2013 were followed through December 31, 2013. Nurses administered the Brief Health Literacy Screen at admission; low health literacy was defined as Brief Health Literacy Screen ≤9. The primary outcome was all-cause mortality. Secondary outcomes were time to first rehospitalization and, separately, time to first emergency department visit within 90 days of discharge. Cox proportional hazards models determined their relationships with health literacy, adjusting for age, gender, race, insurance, education, comorbidity, and hospital length of stay. For the 1379 patients, average age was 63.1 years, 566 (41.0%) were female, and 324 (23.5%) had low health literacy. Median follow-up was 20.7 months (interquartile range 12.8 to 29.6 months), and 403 (29.2%) patients died. Adjusted hazard ratio [aHR] for death among patients with LHL was 1.32 (95%confidence interval [CI] 1.05, 1.66, P=0.02) compared to BHLS>9 [corrected].Within 90 days of discharge, there were 415 (30.1%) rehospitalizations and 201 (14.6%) emergency department visits, with no evident association with health literacy.


CONCLUSIONS
Lower health literacy was associated with increased risk of death after hospitalization for acute heart failure. There was no evident relationship between health literacy and 90-day rehospitalization or emergency department visits.
Department of Emergency Medicine, Vanderbilt University, Nashville, TN (C.D.M.N., A.B.S.).
Candace D
CD
McNaughton
Department of Medicine, Vanderbilt University, Nashville, TN (C.C., S.K., C.L.R.).
Courtney
C
Cawthon
Department of Medicine, Vanderbilt University, Nashville, TN (C.C., S.K., C.L.R.).
Sunil
S
Kripalani
Department of Biostatistics, Vanderbilt University, Nashville, TN (D.L.).
Dandan
D
Liu
Department of Emergency Medicine, Vanderbilt University, Nashville, TN (C.D.M.N., A.B.S.).
Alan B
AB
Storrow
Department of Medicine, Vanderbilt University, Nashville, TN (C.C., S.K., C.L.R.) Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville, TN (C.L.R.).
Christianne L
CL
Roumie
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000523:psychology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D000067010:Literacy / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
health literacy; health services research; heart failure; mortality