Health Literacy, Cognitive Function, and Mortality in Patients With Heart Failure.
Health Literacy, Cognitive Function, and Mortality in Patients With Heart Failure.
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DOI：
10.1097/jcn.0000000000000855
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发表时间：
2022-01-01
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影响因子：
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通讯作者：
Hughes JW
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作者：
Kuhn TA;Gathright EC;Dolansky MA;Gunstad J;Josephson R;Hughes JW
健康素养可以预测心力衰竭的死亡率。然而，认知功能在这种关系中的作用尚未得到评估。我们假设健康素养可以预测全因死亡率，但认知功能可以改变健康素养与心力衰竭死亡率之间的关系。研究心力衰竭患者的健康素养、认知功能和死亡率之间的关系。一项大型研究的次要分析包括298例射血分数降低（HFrEF）心力衰竭患者（试验标识符：NCT 01461629）。健康素养的评估使用快速评估成人识字率在医学（REALM）和医学术语识别测试（METER），认知功能与修改的简易精神状态检查（3 MS）。采用考克斯比例风险回归，以至死亡时间作为因变量。在控制年龄、性别和种族后，METER和REALM评分均不能预测心力衰竭的死亡率（p ≥ .37）。然而，在使用METER（Δχ2 = 9.20，p <0.01; B =-0.07; HR，0.94 [95% CI，0.89 - 0.98]; p <0.01）和REALM（Δχ2 = 9.77，p <0.01; B =-0.07; HR，0.94 [95% CI，0.90 - 0.97]; p <0.01）的模型中，3 MS预测了死亡率。此外，添加3 MS改进了模型拟合。认知功能比健康素养更能预测心力衰竭的死亡率。结果表明，需要进一步评估认知功能对心力衰竭患者死亡风险增加的贡献。
Health literacy has predicted mortality in heart failure. However, the role of cognitive functioning in this relationship has not been evaluated. We hypothesized that health literacy would predict all-cause mortality, but that cognitive functioning would modify the relationship between health literacy and mortality in heart failure. To examine the association between health literacy, cognitive functioning, and mortality in patients with heart failure. This secondary analysis of a larger study included 298 patients with heart failure with reduced ejection fraction (HFrEF) (Trial identifier: NCT01461629). Health literacy was evaluated using the Rapid Estimate of Adult Literacy in Medicine (REALM) and Medical Term Recognition Test (METER), and cognitive functioning with the Modified Mini-Mental Status Examination (3MS). Cox proportional hazards regression was used with time-until-death as the dependent variable. After controlling for age, sex, and race, neither METER nor REALM scores predicted mortality in heart failure (p’s ≥ .37). However, 3MS predicted mortality in models using the METER (Δχ2 = 9.20, p < .01; B = −.07; HR, .94 [95% CI, .89–.98]; p < .01) and REALM (Δχ2 = 9.77, p < .01; B = −.07; HR, 0.94 [95% CI, .90–.97]; p <.01). Furthermore, adding the 3MS improved model fit. Cognitive functioning predicted mortality in heart failure better than health literacy. Results suggest the need to further evaluate the contribution of cognitive functioning to increased risk of mortality in those with heart failure.