Lower health literacy linked to high risk of mortality for cardiovascular patients

Patients hospitalized with a cardiovascular event are more likely to die within one year if they have low health literacy, according to a Vanderbilt University Medical Center study released today in Mayo Clinic Proceedings.

Health literacy is the ability to access and use reliable health information to make decisions, according to the study's lead author Lindsay Mayberry, PhD, assistant professor of Medicine.

The study followed 3,000 patients hospitalized for cardiovascular disease at Vanderbilt University Adult Hospital with acute coronary syndrome, heart failure or both.

The study considered how sick patients were -- co-morbidities, type of cardiovascular disease, recent hospitalizations -- but also looked at social and behavioral factors including social support, medication adherence, smoking behavior, and physical activity.

Another consideration was perceived health competence, meaning how confident patients were that they could affect their own health outcomes.

"The mechanisms that were linking lower health literacy and premature mortality were not only how sick the patient was but also things patients have control over like health behaviors and how much they believe that they can change their outcomes," Mayberry said. "The effects were sizeable even alongside clinical predictors that we would expect to be really powerful. Someone with very low health literacy was about 13 percent more likely to die within a year than someone with very high health literacy."

Mayberry said the paper underlines the importance of screening for health literacy when patients are hospitalized and making sure that health information is delivered in ways that patients can understand.

"Your health behaviors and this sense of control over your health outcome, independent of how sick you are, are really important," she said. "Increasing physical activity, stopping smoking and reducing alcohol intake are really important things that patients can control, especially after a hospitalization for cardiovascular disease.

"And there is also this psychological component, independent of your health behavior, just this belief that you have control over your health outcomes that is also protective," she said.

Interventions such as cardiac rehab and health coaching are also beneficial in helping patients improve health behavior and health competence after cardiovascular events, and may be especially important for patients with lower health literacy, she said.

The study of Vanderbilt patients with cardiovascular disease is one of the first to look at what mechanisms might link lower health literacy and increased risk for mortality and would be important to replicate in other areas, Mayberry said.

Principal investigator Sunil Kripalani, MD, MSc, associate professor of Medicine, added that the "research highlights the important role of social and behavioral factors in determining patients' health outcomes, while pointing us toward potential strategies to help the 20-30 percent of adults with low health literacy."

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