Original article
Health Literacy and Health Outcomes in Very Old Patients With Heart FailureAlfabetización en salud y resultados de salud en pacientes muy ancianos con insuficiencia cardiaca

https://doi.org/10.1016/j.rec.2017.06.010Get rights and content

Abstract

Introduction and objectives

Health literacy (HL) has been associated with lower mortality in heart failure (HF). However, the results of previous studies may not be generalizable because the research was conducted in relatively young and highly-educated patients in United States settings. This study assessed the association of HL with disease knowledge, self-care, and all-cause mortality among very old patients, with a very low educational level.

Methods

This prospective study was performed in 556 patients (mean age, 85 years), with high comorbidity, admitted for HF to the geriatric acute-care unit of 6 hospitals in Spain. About 74% of patients had less than primary education and 71% had preserved systolic function. Health literacy was assessed with the Short Assessment of Health Literacy for Spanish-speaking Adults questionnaire, knowledge of HF with the DeWalt questionnaire, and HF self-care with the European Heart Failure Self-Care Behaviour Scale.

Results

Disease knowledge progressively increased with HL; compared with being in the lowest (worse) tertile of HL, the multivariable beta coefficient (95%CI) of the HF knowledge score was 0.60 (0.01-1.19) in the second tertile and 0.87 (0.24-1.50) in the highest tertile, P-trend = .008. However, no association was found between HL and HF self-care. During the 12 months of follow-up, there were 189 deaths. Compared with being in the lowest tertile of HL, the multivariable HR (95%CI) of mortality was 0.84 (0.56-1.27) in the second tertile and 0.99 (0.65-1.51) in the highest tertile, P-trend = .969.

Conclusions

No association was found between HL and 12-month mortality. This could be partly due to the lack of a link between HL and self-care.

Resumen

Introducción y objetivos

La alfabetización en salud (AS) se ha asociado con menor mortalidad en pacientes con insuficiencia cardiaca (IC) relativamente jóvenes y de alto nivel educativo en Estados Unidos. Este estudio evalúa la asociación de la AS con el conocimiento de la enfermedad, el autocuidado y la mortalidad por cualquier causa en pacientes muy ancianos con muy bajo nivel educativo.

Métodos

Estudio prospectivo con 556 pacientes (media de edad, 85 años) con mucha comorbilidad admitidos por IC en las unidades geriátricas de 6 hospitales españoles. El 74% de los pacientes tenían estudios inferiores a los primarios y el 71%, función sistólica conservada. La AS se valoró con el cuestionario Short Assessment of Health Literacy for Spanish-speaking Adults; el conocimiento sobre la IC, con el cuestionario de DeWalt, y el autocuidado, con la European Heart Failure Self-Care Behaviour Scale.

Resultados

El conocimiento sobre la IC aumenta con la AS; comparado con el tercil inferior de AS, el coeficiente beta multivariado (IC95%) de conocimiento sobre la IC fue 0,60 (0,01-1,19) en el segundo tercil y 0,87 (0,24-1,50) en el tercil superior (p de tendencia = 0,008). Sin embargo, la AS no se asoció con el autocuidado de la IC. En los 12 meses de seguimiento hubo 189 muertes. Comparado con el tercil inferior de AS, la HR multivariable (IC95%) de mortalidad fue 0,84 (0,56-1,27) en el segundo tercil y 0,99 (0,65-1,51) en el tercil superior (p de tendencia = 0,969).

Conclusiones

No se observó asociación entre la AS y la mortalidad a los 12 meses. Esto puede explicarse en parte por la falta de asociación entre AS y autocuidado.

Section snippets

INTRODUCTION

Health literacy (HL) is the degree to which individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions.1 Adequate HL is important to ensure proper patient-clinician interaction, full understanding of health counseling and treatment prescription, and competent self-care.2 Therefore, HL is of particular importance for those patients with complex health problems requiring long-term self-management. A good example of this type

Study Design and Participants

We conducted a prospective cohort study of participants in the HF-geriatrics randomized controlled trial, which assessed the effectiveness of a disease management program among very old patients with HF and major comorbidity (ClinicalTrials.gov number, NCT01076465). The study methods and main results have been published elsewhere.12, 13 Briefly, we recruited patients aged ≥ 75 years admitted with a primary diagnosis of HF to the geriatric acute-care unit of 6 hospitals in Spain. Diagnosis of HF

RESULTS

Among study participants, the mean ± standard deviation age was 85.6 ± 5.1 years, 62.2% were women, 70.5% had preserved systolic function, and 43.8% had been hospitalized for HF in the last year. A total of 73.7% has less than primary education. The frequency of morbidity was high, because ischemic heart disease was present in 16.8%, chronic obstructive lung disease in 31.3%, diabetes in 33.9%, hypertension in 81.8%, and depression in 34%, the Mini-mental State Examination score was < 22 in

DISCUSSION

In this prospective study of very old patients with high comorbidity admitted for HF to 6 Spanish hospitals, a higher HL was associated with greater HF knowledge at 6 months post-discharge; however, no association was found between HL and HF self-care at 6 months post-discharge or all-cause mortality during a 12-month follow-up.

Our results are in line with those of previous studies on the association between HL and disease knowledge in patients with HF. Specifically, we are aware of 5 studies

CONCLUSIONS

In this prospective study of very old patients with substantial comorbidity who were hospitalized for HF within a free-access high-quality health care system in Spain, we found no association between HL and 12-month all-cause mortality. These null results could be partly due to a lack of association between higher HL and better HF self-care at 6 months post-discharge. Future studies should confirm these results with instruments assessing all dimensions of HL. In addition, they should collect

FUNDING

This work was funded by grants PI09/91064, PI11/640, PI12/1166 and PI14/01044 from the Instituto de Salud Carlos III (Secretary of R+D+I and European Regional Development Fund/European Social Fund).

CONFLICTS OF INTEREST

None declared.

WHAT IS KNOWN ABOUT THE TOPIC?

  • Among patients with HF, HL is associated with better disease knowledge but the impact of HL on self-care is uncertain.

  • Health literacy has been associated with lower mortality in HF, but the results of previous studies may not be generalizable because the research was conducted with relatively young and highly-educated patients in United States settings.

WHAT DOES THIS STUDY ADD?

  • Among very old patients, with low educational level, admitted for HF in 6 hospitals in Spain, no association was found between HL

References (30)

  • C.W. Yancy et al.

    American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines

    Circulation.

    (2013)
  • P. Ponikowski et al.

    2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC

    Eur Heart J.

    (2016)
  • C. Westlake et al.

    How can health literacy influence outcomes in heart failure patients? Mechanisms and interventions

    Curr Heart Fail Rep.

    (2013)
  • M.I. Cajita et al.

    Health Literacy and Heart Failure: A Systematic Review

    J Cardiovasc Nurs.

    (2016)
  • P.N. Peterson et al.

    Health literacy and outcomes among patients with heart failure

    JAMA.

    (2011)
  • Cited by (0)

    These authors have contributed equally and should be considered first authors.

    View full text