A systematic review and meta-analysis including more than a dozen studies found inadequate health literacy could increase risk of mortality 41% and risk of hospitalization by 12%, even after adjustment for covariates including age, sex, education, and confounding factors.
Led by clinicians from the Mayo Clinic in Rochester, MN, a team of investigators conducted the current study to determine if health literacy was associated with mortality, hospitalizations, or emergency department visits among patients with heart failure. Using the Embase, MEDLINE, PsycINFO, and EBSCO CINAHL from inception through January 1, 2019, the investigators’ analysis identified more than 1500 interventional and observational studies for inclusion.
For the purpose of their study, investigators included observational studies evaluated health literacy among patients with heart failure, focused on adults 18 years of older without a left ventricular asset device, and examined mortality, hospitalizations, or emergency department visits as an outcome. Interventions studies included proposed an intervention for patients with inadequate literacy or health literacy-sensitive intervention, focused on patients 18 or older with heart failure, and examine mortality, hospitalizations, emergency department visits, or a combination of the 3 as an outcome.
Of note, investigators excluded published articles classified as editorials, conference abstracts, narrative reviews, letters, and errata and qualitative research. From the 15 studies included in the final analyses, investigators extracted information related to year and the location where the study was conducted, age and sex characteristics of the cohort, study design, how the diagnosis of heart failure was made, if heart failure was prevalent or incident, how health literacy was evaluated, and which outcome was assessed.
For the current study, outcomes of interest included all-cause death, hospitalizations, and emergency department visits. Only incident hospitalizations and emergency department visits were included by investigators for analysis.
Of the 15 studies included in the systematic review, 5 examined the impact of health literacy on mortality in patients with heart failure. These studies indicated inadequate health literacy was linked to a 67% increase in mortality in unadjusted analyses and a statistically significant 41% increase in risk for mortality following adjustment (RR, 1.41; 95% CI, 1.06-1.87; I2=77%).
In total, 8 studies examined hospitalizations for heart failure. Among the participants of these studies, 20% had inadequate health literacy. Results indicated inadequate health literacy increased risk for hospitalization nearly 20% in unadjusted analyses and a 12% increase in adjusted analyses (RR, 1.12; 95% CI, 1.01-1.25; I2=0%).
For emergency department visits, 4 studies including 2544 patients were identified as part of the systematic review. OF these 2544 patients, 29% were considered to have inadequate health literacy. Unadjusted analyses indicated inadequate health literacy increased risk of emergency department visits more than 15%, but this association was not statically significant after adjustment (RR, 1.02; 95% CI, 0.83-1.25; I2=15%).
“Among patients with HF, an inadequate level of health literacy is frequent and associated with an increased risk of deaths and hospitalizations. These findings have important clinical and public health implications and support the deployment of interventions to improve health literacy to improve outcomes among patients living with HF,” wrote investigators.
This study, “Health Literacy and Outcomes Among Patients With Heart Failure,” was published in JACC: Heart Failure.