Objectives

The purpose of this study was to determine if health literacy is associated with mortality, hospitalizations, or emergency department (ED) visits among patients living with heart failure (HF).

Background

Growing evidence suggests an association between health literacy and health-related outcomes in patients with HF.

Methods

We searched Embase, MEDLINE, PsycINFO, and EBSCO CINAHL from inception through January 1, 2019, with the help of a medical librarian. Eligible studies evaluated health literacy among patients with HF and assessed mortality, hospitalizations, and ED visits for all causes with no exclusion by time, geography, or language. Two reviewers independently selected studies, extracted data, and assessed the methodological quality of the identified studies.

Results

We included 15 studies, 11 with an overall high methodological quality. Among the observational studies, an average of 24% of patients had inadequate or marginal health literacy. Inadequate health literacy was associated with higher unadjusted risk for mortality (risk ratio [RR]: 1.67; 95% confidence interval [CI]: 1.18 to 2.36), hospitalizations (RR: 1.19; 95% CI: 1.09 to 1.29), and ED visits (RR: 1.17; 95% CI: 1.03 to 1.32). When the adjusted measurements were combined, inadequate health literacy remained statistically associated with mortality (RR: 1.41; 95% CI: 1.06 to 1.88) and hospitalizations (RR: 1.12; 95% CI: 1.01 to 1.25). Among the 4 interventional studies, 2 effectively improved outcomes among patients with inadequate health literacy.

Conclusions

In this study, the estimated prevalence of inadequate health literacy was high, and inadequate health literacy was associated with increased risk of death and hospitalizations. These findings have important clinical and public health implications and warrant measurement of health literacy and deployment of interventions to improve outcomes.

中文翻译：

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心力衰竭患者的健康素养和结果：系统评价和荟萃分析。

目标

这项研究的目的是确定健康素养是否与心力衰竭（HF）患者之间的死亡率，住院或急诊就诊有关。

背景

越来越多的证据表明，HF患者的健康素养与健康相关结果之间存在关联。

方法

从一开始到2019年1月1日，我们在医学图书馆员的帮助下搜索了Embase，MEDLINE，PsycINFO和EBSCO CINAHL。符合条件的研究评估了HF患者的健康素养，并评估了所有原因的死亡率，住院和ED就诊，没有时间，地理或语言的排斥。两名审稿人独立选择研究，提取数据并评估已鉴定研究的方法学质量。

结果

我们纳入了15项研究，其中11项具有较高的方法学质量。在观察性研究中，平均24％的患者的健康素养不足或处于边缘地位。健康素养不足与较高的未调整死亡率相关（风险比[RR]：1.67； 95％置信区间[CI]：1.18至2.36），住院治疗（RR：1.19； 95％CI：1.09至1.29）和ED造访（RR：1.17； 95％CI：1.03至1.32）。当结合调整后的测量值时，健康素养不足与死亡率（RR：1.41； 95％CI：1.06至1.88）和住院（RR：1.12； 95％CI：1.01至1.25）在统计学上仍然相关。在4项干预性研究中，有2项有效地改善了健康素养不足的患者的预后。

结论

在这项研究中，估计的健康素养不足患病率很高，健康素养不足与死亡和住院风险增加相关。这些发现具有重要的临床和公共卫生意义，并需要对健康素养进行测量并采取干预措施以改善结果。