Low-health Literate Patients With Heart Failure Are At An Increased Risk Of Readmission

Abstract

PURPOSE: Health literacy (HL) is the degree to which individuals can obtain, process, and understand basic health information and services needed to make proper health decisions. Low-HL is associated with reduced adherence to exercise, medications, healthy nutrition, and low utilization of preventive health services. Cardiac Rehabilitation (CR) is a secondary prevention program that targets risk factor education and reduction, to associated improvements in health status. Heart failure (HF) has recently been added as an eligible diagnosis for CR, and it is associated with particularly high rates of readmission. We hypothesized that that low-HL may contribute to high hospital readmission among HF patients. To evaluate differences in hospital readmission rates for HF patients who did and did not attend CR. To compare rehospitalization in relation to low- versus (vs) high-HL in the HF patients who attended CR. METHODS: Retrospective quality improvement analysis. Comparison of matched HF patients who did versus did not attend CR. We then assessed HL in those who attended CR to compare 30-day and 90-day readmissions in patients with low-HL (less than 9th grade reading level) vs high-HL (greater than 9th grade reading level). HL was evaluated using the REALM-SF. RESULTS: Readmissions in 104 HF patients who attended CR were significantly lower than in the HF patients who did not attend CR (17.44% vs 21% at 30 days, and 22.62 vs. 39.3% at 90 days). Among the 104 HF patients who attended CR, 67 who categorized as high-HL had significantly lower readmission than the 37 who categorized as low-HL at both 30 (8.96% vs 29.73, p=0.0061) and 90 days (22.39% vs. 40.54%, p=0.05). CONCLUSIONS: CR enrollment was associated with reduced readmission in HF patients. Among HF patients who attend CR, low-HL was associated with relatively greater risks of rehospitalization compared to patients with high-HL, suggesting that refinements to address low-HL might improve the efficacy of CR.