Abstract 127: The Association Between Health Literacy And 90-day Re-hospitalization or Death: A Cohort Study of Patients Hospitalized for Heart Failure
Background: More than 20% of patients hospitalized for heart failure are readmitted. Low health literacy, or the ability to read, understand, and use healthcare information to make decisions is associated with the reduced ability to participate in self-management.
Objective: Examine the relationship between health literacy and a composite outcome of re-hospitalization or death within 90 days after index heart failure admission. Re-hospitalization or death were separate secondary outcomes.
Methods: Patients discharged from a single referral institution between November 2010 and June 2013 with a primary diagnosis of heart failure and complete information on the nurse administered health literacy were included. The first eligible admission was included. At hospitalization, nurses administered the Brief Health Literacy Screen (BHLS). The BHLS (range 3-15) consists of three self-report questions and higher scores indicate higher health literacy. Low health literacy was defined as BHLS ≤9. Date of death was obtained from the Social Security Death Index and health record. Re-admissions within 90 days of discharge were tracked using standardized methods. Cox proportional hazards evaluated the association between low health literacy and the composite outcome adjusting for age, gender, race, and insurance.
Results: For 1708 patients discharged for heart failure, mean age was 64.3 years (standard deviation, 15.1 years), 42.5% were female, 20.6% were African American, and 50.7% were covered only by Medicare Part A. Low health literacy was found in 18.6%. There were 601 (35.7%) composite events (129 deaths and 586 readmissions) within 90 days (35.4%, adequate health literacy vs. 35.1%, low health literacy). Adjusted hazard ratio (HR) for the composite outcome was 0.99 (95% CI 0.96, 1.01) per point increase in BHLS; adjusted HR for death within 90 days was 0.94 (95% CI 0.89, 0.99, p=0.02) per point increase in BHLS. Kaplan Meier failure plot for the composite outcome is below.
Conclusions: In this single center cohort study of hospitalized heart failure patients, readmission within 90 days was common. Health literacy was not associated with the composite outcome of re-hospitalization or death within 90 days. However, higher health literacy was associated with lower risk of death within 90 days.
Author Disclosures: C.D. McNaughton: B. Research Grant; Significant; Vanderbilt Emergency Medicine Research Training Program (NIH K12HL109019). G. Consultant/Advisory Board; Modest; Cornerstone Therapeutics. S. Kripalani: None. C. Cawthon: None. C.L. Roumie: None.
- © 2014 by American Heart Association, Inc.