Low Health Literacy Linked To Increased Mortality

Candace McNaughton, MD MPH Assistant Professor Department of Emergency Medicine Vanderbilt University, Nashville, TNMedicalResearch.com Interview with:
Candace McNaughton, MD MPH
Assistant Professor
Department of Emergency Medicine
Vanderbilt University, Nashville, TN

Medical Research: What is the background for this study?

Dr. McNaughton: Heart failure affects more than 5 million Americans, is a frequent cause of hospitalization, and by 2030 is projected to cost as much $70 billion, so there is a lot of interest in helping patients with heart failure manage their condition. Health literacy, or the ability to use and understand healthcare information, is important for all patients, but the stakes are very high for patients with heart failure. Some people who are highly literate or highly educated in other areas may have difficulty reading and understanding healthcare information. Patients with lower health literacy skills may have difficulty communicating with healthcare providers, navigating the healthcare system, recognizing signs of health decline, and knowing when and who to contact when they do become ill.

Medical Research: What are the main findings?

Dr. McNaughton: To our knowledge, this is the first study in which health literacy was measured by nurses when patients were admitted to the hospital for heart failure. Nurses asked patients three questions about whether they have problems learning about their medical condition, their confidence filling out medical forms, and how often they have someone help them read hospital materials. With these three questions, information about the health literacy level of individual patients can be made easily available their healthcare providers.

We found that among 1,379 patients hospitalized for acute heart failure, those with low health literacy had 32% greater risk of death compared to patients with a literacy score of 10 or higher, even after adjusting age, sex, race, insurance status, education, other medical conditions, and how long they were in the hospital. 

Medical Research: What should clinicians and patients take away from your report?

Dr. McNaughton: The most important takeaway is that clear communication is very important.  It’s important that patients feel empower to let their healthcare providers know when they have questions or concerns. Healthcare providers often overestimate the health literacy levels of their patients, so they may not know there is a problem. It is important that patients talk with their healthcare providers and ask questions until they have a good understanding of how to take their medications, what the goals for salt and water intake, water weight, and how to balance all of this with other conditions such as diabetes.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. McNaughton: We are learning more and more about how to make the most of communication between patients and healthcare providers.  For many healthcare providers, it is often difficult to know which patients have low health literacy – for example, patients with graduate degrees can have difficulty understanding healthcare information because the information and language can be quite specialized. When we identify low health literacy levels, should we simplify medication regimens? Follow patients in the outpatient setting more frequently or sooner after discharge? Give them extra resources like home health care? We don’t know the answers to these questions yet.

Citation:

Health Literacy and Mortality: A Cohort Study of Patients Hospitalized for Acute Heart Failure

Candace D. McNaughton, Courtney Cawthon, Sunil Kripalani, Dandan Liu, Alan B. Storrowand Christianne L. Roumie

J Am Heart Assoc. 2015;4:e001799, originally published April 29, 2015, doi:10.1161/JAHA.115.001799

MedicalResearch.com Interview with: Candace McNaughton, MD MPH (2015). Low Health Literacy Linked To Increased Mortality