TY - JOUR
T1 - Health Literacy and Outcomes Among Patients With Heart Failure
T2 - A Systematic Review and Meta-Analysis
AU - Fabbri, Matteo
AU - Murad, M. Hassan
AU - Wennberg, Alexandra M.
AU - Turcano, Pierpaolo
AU - Erwin, Patricia J.
AU - Alahdab, Fares
AU - Berti, Alvise
AU - Manemann, Sheila M.
AU - Yost, Kathleen J.
AU - Finney Rutten, Lila J.
AU - Roger, Véronique L.
N1 - Funding Information:
This publication was made possible by Clinical and Translational Science Awards grant number UL1 TR002377 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health (NIH), and the National Heart, Lung and Blood Institute (R01 HL120859). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. Dr. Finney Rutten serves as a consultant with Exact Sciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/6
Y1 - 2020/6
N2 - Objectives: The purpose of this study was to determine if health literacy is associated with mortality, hospitalizations, or emergency department (ED) visits among patients living with heart failure (HF). Background: Growing evidence suggests an association between health literacy and health-related outcomes in patients with HF. Methods: We searched Embase, MEDLINE, PsycINFO, and EBSCO CINAHL from inception through January 1, 2019, with the help of a medical librarian. Eligible studies evaluated health literacy among patients with HF and assessed mortality, hospitalizations, and ED visits for all causes with no exclusion by time, geography, or language. Two reviewers independently selected studies, extracted data, and assessed the methodological quality of the identified studies. Results: We included 15 studies, 11 with an overall high methodological quality. Among the observational studies, an average of 24% of patients had inadequate or marginal health literacy. Inadequate health literacy was associated with higher unadjusted risk for mortality (risk ratio [RR]: 1.67; 95% confidence interval [CI]: 1.18 to 2.36), hospitalizations (RR: 1.19; 95% CI: 1.09 to 1.29), and ED visits (RR: 1.17; 95% CI: 1.03 to 1.32). When the adjusted measurements were combined, inadequate health literacy remained statistically associated with mortality (RR: 1.41; 95% CI: 1.06 to 1.88) and hospitalizations (RR: 1.12; 95% CI: 1.01 to 1.25). Among the 4 interventional studies, 2 effectively improved outcomes among patients with inadequate health literacy. Conclusions: In this study, the estimated prevalence of inadequate health literacy was high, and inadequate health literacy was associated with increased risk of death and hospitalizations. These findings have important clinical and public health implications and warrant measurement of health literacy and deployment of interventions to improve outcomes.
AB - Objectives: The purpose of this study was to determine if health literacy is associated with mortality, hospitalizations, or emergency department (ED) visits among patients living with heart failure (HF). Background: Growing evidence suggests an association between health literacy and health-related outcomes in patients with HF. Methods: We searched Embase, MEDLINE, PsycINFO, and EBSCO CINAHL from inception through January 1, 2019, with the help of a medical librarian. Eligible studies evaluated health literacy among patients with HF and assessed mortality, hospitalizations, and ED visits for all causes with no exclusion by time, geography, or language. Two reviewers independently selected studies, extracted data, and assessed the methodological quality of the identified studies. Results: We included 15 studies, 11 with an overall high methodological quality. Among the observational studies, an average of 24% of patients had inadequate or marginal health literacy. Inadequate health literacy was associated with higher unadjusted risk for mortality (risk ratio [RR]: 1.67; 95% confidence interval [CI]: 1.18 to 2.36), hospitalizations (RR: 1.19; 95% CI: 1.09 to 1.29), and ED visits (RR: 1.17; 95% CI: 1.03 to 1.32). When the adjusted measurements were combined, inadequate health literacy remained statistically associated with mortality (RR: 1.41; 95% CI: 1.06 to 1.88) and hospitalizations (RR: 1.12; 95% CI: 1.01 to 1.25). Among the 4 interventional studies, 2 effectively improved outcomes among patients with inadequate health literacy. Conclusions: In this study, the estimated prevalence of inadequate health literacy was high, and inadequate health literacy was associated with increased risk of death and hospitalizations. These findings have important clinical and public health implications and warrant measurement of health literacy and deployment of interventions to improve outcomes.
KW - ED visits
KW - health literacy
KW - heart failure
KW - hospitalization
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85085096837&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85085096837&partnerID=8YFLogxK
U2 - 10.1016/j.jchf.2019.11.007
DO - 10.1016/j.jchf.2019.11.007
M3 - Article
C2 - 32466837
AN - SCOPUS:85085096837
VL - 8
SP - 451
EP - 460
JO - JACC: Heart Failure
JF - JACC: Heart Failure
SN - 2213-1779
IS - 6
ER -