Abstract
The purpose of this study was to identify the prevalence of low health literacy (HL) and to determine whether low HL contributes to poorer disease knowledge, self-care, and clinical outcomes in ambulatory patients with heart failure (HF). We enrolled 147 English-speaking patients from our ambulatory HF clinics between January 2015 and February 2016. HL was measured with the Newest Vital Sign, knowledge with the English-version Dutch Heart Failure Knowledge Scale, and self-care with the Self-Care Heart Failure Index. Information on mortality, hospitalizations, heart transplant (HT) or left ventricular assist device (LVAD) implant were collected over two years. Primary analysis was multivariable linear or univariable logistic regression. Level of significance for all tests was pre-set at 0.05. The sample was predominantly male (73.1%) with an average age of 56.8 ± 14 years. 44 (30.3%) had low HL. Patients with low HL were significantly older (56.8 vs 54.4 years) had less formal education (47.7% vs 75.2% post-secondary), and spoke English as a second language (40.9% vs 15.8%). Patients with low HL had lower HF knowledge scores (10.8 vs 12.5). There were no significant associations between HL and self-care scores. At 18 months the risk of death, HT or LVAD was 3% for patients with adequate HL versus 24% for low HL (OR 0.28; 95% CI: 0.10-0.78, p<0.05). This study found that 30% of patients with HF have low HL. Low HL is characterized by increased age, less formal education, and English as a second language. Patients with low HL had worse outcomes at 18 months despite no difference in self-reported self-care measures.
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