Prognostic implications of a one-item health literacy screen on health status outcomes among heart failure patients with depression

BACKGROUND: Health literacy (HL) is the degree to which individuals can obtain, process, and understand basic health information and services. Although low HL portends greater risk for clinical events, its association with heart failure (HF)-specific health status– patients’ symptoms, function and quality of life– is poorly understood. We thus explored the association of low HL with health status outcomes in depressed patients with HF, for whom treatment regimens can be complex. METHODS: Participants with HF with reduced ejection fraction and depression, from the Hopeful Heart trial, were categorized as having low or adequate HL at baseline using a validated, 1-item HL screen. HF-specific health status was measured at baseline, 3, 6, and 12 months using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Using serial risk-adjusted linear regression models, we assessed the association of HL with baseline, 12-month and 12-month change in the KCCQ Overall Summary (OS) scores (range 0–100; lower scores = worse health status). RESULTS: Among 629 participants, 35 % had low HL. Those with low HL had lower health status at all time points, including at 12 months after discharge (−9.8 points, 95%CI [−14.3, −5.3], p < 0.001), with poorer improvements in KCCQ-OS scores after accounting for baseline health status (−6.4 points, 95%CI [−10.5, −2.3], p = 0.002). CONCLUSIONS: In those with HF and depression, low HL was common and associated with worse HF-specific health status and poorer improvement over time. A brief HL screen can identify patients at risk for poorer health status outcomes and for whom additional interventions may be warranted.