Health literacy and mortality: a cohort study of patients hospitalized for acute heart failure.
Health literacy and mortality: a cohort study of patients hospitalized for acute heart failure.
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DOI：
10.1161/jaha.115.001799
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发表时间：
2015-04-29
影响因子：
5.4
通讯作者：
Roumie CL
中科院分区：
文献类型：
--
作者：
McNaughton CD;Cawthon C;Kripalani S;Liu D;Storrow AB;Roumie CL
30%以上因心力衰竭住院的患者在出院后90天内再次住院或死亡。较低的健康素养与慢性心力衰竭门诊患者的死亡率相关；对于急性心力衰竭住院后的这种关系知之甚少。2010年11月至2013年6月期间因急性心力衰竭住院并出院的患者随访至2013年12月31日。护士在入院时进行简短健康素养筛查；健康素养低定义为健康素养简要筛查≤9。主要结局为全因死亡率。次要结果是第一次再住院的时间，以及出院90天内第一次急诊室就诊的时间。Cox比例风险模型确定了它们与健康素养的关系，调整了年龄、性别、种族、保险、教育程度、合并症和住院时间。1379例患者平均年龄63.1岁，女性566例（41.0%），健康素养低324例（23.5%）。中位随访时间为20.7个月（四分位数间距12.8 ~ 29.6个月），403例（29.2%）患者死亡。与简要健康素养筛查bbb9相比，低健康素养患者的调整死亡风险比为1.34 （95% CI 1.04, 1.73， P=0.02）。出院后90天内，有415例（30.1%）再次住院，201例（14.6%）急诊就诊，与健康素养无明显关联。较低的健康素养与急性心力衰竭住院后死亡风险增加有关。健康素养与90天再住院或急诊就诊之间无明显关系。
More than 30% of patients hospitalized for heart failure are rehospitalized or die within 90 days of discharge. Lower health literacy is associated with mortality among outpatients with chronic heart failure; little is known about this relationship after hospitalization for acute heart failure. Patients hospitalized for acute heart failure and discharged home between November 2010 and June 2013 were followed through December 31, 2013. Nurses administered the Brief Health Literacy Screen at admission; low health literacy was defined as Brief Health Literacy Screen ≤9. The primary outcome was all-cause mortality. Secondary outcomes were time to first rehospitalization and, separately, time to first emergency department visit within 90 days of discharge. Cox proportional hazards models determined their relationships with health literacy, adjusting for age, gender, race, insurance, education, comorbidity, and hospital length of stay. For the 1379 patients, average age was 63.1 years, 566 (41.0%) were female, and 324 (23.5%) had low health literacy. Median follow-up was 20.7 months (interquartile range 12.8 to 29.6 months), and 403 (29.2%) patients died. Adjusted hazard ratio for death among patients with low health literacy was 1.34 (95% CI 1.04, 1.73, P=0.02) compared to Brief Health Literacy Screen >9. Within 90 days of discharge, there were 415 (30.1%) rehospitalizations and 201 (14.6%) emergency department visits, with no evident association with health literacy. Lower health literacy was associated with increased risk of death after hospitalization for acute heart failure. There was no evident relationship between health literacy and 90-day rehospitalization or emergency department visits.