title: Health Literacy Mediates the Relationship Between Age and Health Outcomes in Patients With Heart Failure.
abstract: BACKGROUND
  Previous studies have linked frequent rehospitalizations for heart failure (HF) and increased mortality with older age, higher severity of HF, lack of an evidence-based medication regimen, and inadequate health literacy. However, the pathway between age and health outcomes in patients with HF remains unknown. Therefore, the purpose of this study was to test whether the association between age and health outcomes can be explained by severity of HF, evidence-based medication use, and health literacy in patients with HF.
  
  
  RESULTS
  This was a longitudinal study of 575 rural patients with HF recruited from outpatient clinics and hospitals. Demographics, clinical data, and health literacy were collected at baseline. HF readmissions and cardiac mortality were followed for 2 years; 57% of patients were ≥ 65 years of age. Older patients with HF were more likely to have low health literacy and less likely to be prescribed angiotensin-converting enzyme inhibitors or β-blockers. Using Kaplan-Meier survival curves with log-rank tests, health outcomes were significantly worse in patients who were ≥ 65 years and in those with low health literacy. Separate Cox regressions revealed that age and health literacy predicted worse health outcomes (P = 0.006 and < 0.001, respectively). When health literacy was entered into the model, the hazard ratio for age changed from 1.49 to 1.29 (a 41% reduction); age was no longer a significant predictor of health outcomes, but health literacy remained significant (P < 0.001), demonstrating mediation.
  
  
  CONCLUSIONS
  Health literacy mediates the relationship between age and health outcomes in adults with HF.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00415545.
authors.affiliation: From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.). jiarongw@email.unc.edu.
authors.forename: Jia-Rong
authors.initials: JR
authors.lastname: Wu
authors.affiliation: From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.).
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.affiliation: From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.).
authors.forename: Darren A
authors.initials: DA
authors.lastname: DeWalt
authors.affiliation: From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.).
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Rayens
authors.affiliation: From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.).
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dracup
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000523:psychology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002423:Cause of Death; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D054625:Healthcare Disparities; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012307:Risk Factors; D012423:Rural Health; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: aging; angiotensin-converting enzyme inhibitors; health literacy; heart failure; longitudinal studies