Health Literacy Predicts Morbidity and Mortality in Rural Patients With Heart Failure

• We studied health literacy in the context of demographic, clinical, and psychologic covariates.
• This was a multicenter study of rural patients.
• Inadequate or marginal health literacy, as assessed by the Short Test of Functional Health Literacy in Adults (STOFHLA), is a significant independent risk factor for heart failure rehospitalization or all-cause mortality among rural heart failure patients.

BackgroundPatients hospitalized with heart failure are often readmitted. Health literacy may play a substantial role in the high rate of readmissions. The purpose of this study was to examine the association of health literacy with the composite end point of heart failure readmission rates and all-cause mortality in patients with heart failure living in rural areas.Methods and ResultsRural adults (n = 575), hospitalized for heart failure within the past 6 months, completed the Short Test of Functional Health Literacy in Adults (STOFHLA) to measure health literacy and were followed for ≥2 years. The percentage of patients with the end point of heart failure readmission or all-cause death was different (P = .001) among the 3 STOFHLA score levels. Unadjusted analysis revealed that patients with inadequate and marginal health literacy were 1.94 (95% confidence interval [CI] 1.43–2.63; P < .001) times, and 1.91 (95% CI 1.36–2.67; P < .001) times, respectively, more likely to experience the outcome. After adjustment for covariates, health literacy remained a predictor of outcomes. Of the other covariates, worse functional class, higher comorbidity burden, and higher depression score predicted worse outcomes.ConclusionsInadequate or marginal health literacy is a risk factor for heart failure rehospitalization or all-cause mortality among rural patients with heart failure.