Health Literacy, Cognitive Function, and Mortality in Patients With Heart Failure

Overview

Journal J Cardiovasc Nurs

Specialties Cardiology & Vascular Diseases
Nursing

Date 2021 Sep 28

PMID 34581712

Citations 3

Authors

Tyler A Kuhn

Emily C Gathright

Mary A Dolansky

John Gunstad

Richard Josephson

Joel W Hughes

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Objective: The aim of this study was to examine the association between health literacy, cognitive functioning, and mortality in patients with heart failure.

Methods: This secondary analysis of a larger study included 298 patients with heart failure with reduced ejection fraction (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 was evaluated using the Modified Mini-Mental Status Examination (3MS). Cox proportional hazards regression was used with time-until-death as the dependent variable.

Results: After controlling for age, sex, and race, neither METER nor REALM scores predicted mortality in heart failure (Ps ≥ .37). However, 3MS predicted mortality in models using the METER (Δχ2 = 9.20, P < .01; B = -.07; hazard ratio, 0.94 [95% confidence interval, 0.89-0.98]; P < .01) and REALM (Δχ2 = 9.77, P < .01; B = -0.07; hazard ratio, 0.94 [95% confidence interval, 0.90-0.97]; P < .01). Furthermore, adding the 3MS improved model fit.

Conclusions: 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.

Citing Articles

Mapping research on cognitive impairment in heart failure patients: A bibliometric analysis from 2013 to 2022.

Zhao Q, Zhu X, Wan X, Wu J, Shen F, Bian F Heliyon. 2024; 10(19):e38955.

PMID: 39430440 PMC: 11490794. DOI: 10.1016/j.heliyon.2024.e38955.

Mapping cognitive function screening instruments for patients with heart failure: A scoping review.

Arseda A, Pahria T, Kurniawan T Belitung Nurs J. 2024; 10(3):240-251.

PMID: 38947299 PMC: 11211750. DOI: 10.33546/bnj.3165.

The Situation-Specific Theory of Heart Failure Self-care: An Update on the Problem, Person, and Environmental Factors Influencing Heart Failure Self-care.

Riegel B, Dickson V, Vellone E J Cardiovasc Nurs. 2022; 37(6):515-529.

PMID: 35482335 PMC: 9561231. DOI: 10.1097/JCN.0000000000000919.

References

Peterson P, Shetterly S, Clarke C, Bekelman D, Chan P, Allen L . Health literacy and outcomes among patients with heart failure. JAMA. 2011; 305(16):1695-701. PMC: 4540335. DOI: 10.1001/jama.2011.512. View

Davis T, Long S, Jackson R, Mayeaux E, George R, Murphy P . Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993; 25(6):391-5. View

Griffin J, Partin M, Noorbaloochi S, Grill J, Saha S, Snyder A . Variation in estimates of limited health literacy by assessment instruments and non-response bias. J Gen Intern Med. 2010; 25(7):675-81. PMC: 2881963. DOI: 10.1007/s11606-010-1304-2. View

Kewcharoen J, Prasitlumkum N, Kanitsoraphan C, Charoenpoonsiri N, Angsubhakorn N, Putthapiban P . Cognitive impairment associated with increased mortality rate in patients with heart failure: A systematic review and meta-analysis. J Saudi Heart Assoc. 2019; 31(4):170-178. PMC: 6614112. DOI: 10.1016/j.jsha.2019.06.001. View

Fabbri M, Yost K, Finney Rutten L, Manemann S, Boyd C, Jensen D . Health Literacy and Outcomes in Patients With Heart Failure: A Prospective Community Study. Mayo Clin Proc. 2017; 93(1):9-15. PMC: 5756510. DOI: 10.1016/j.mayocp.2017.09.018. View

Holm H, Bachus E, Jujic A, Nilsson E, Wadstrom B, Molvin J . Cognitive test results are associated with mortality and rehospitalization in heart failure: Swedish prospective cohort study. ESC Heart Fail. 2020; 7(5):2948-2955. PMC: 7524063. DOI: 10.1002/ehf2.12909. View

Chen A, Yehle K, Plake K, Murawski M, Mason H . Health literacy and self-care of patients with heart failure. J Cardiovasc Nurs. 2011; 26(6):446-51. PMC: 3134625. DOI: 10.1097/JCN.0b013e31820598d4. View

Van Patten R, Britton K, Tremont G . Comparing the Mini-Mental State Examination and the modified Mini-Mental State Examination in the detection of mild cognitive impairment in older adults. Int Psychogeriatr. 2018; 31(5):693-701. DOI: 10.1017/S1041610218001023. View

Moser D, Robinson S, Biddle M, Pelter M, Nesbitt T, Southard J . Health Literacy Predicts Morbidity and Mortality in Rural Patients With Heart Failure. J Card Fail. 2015; 21(8):612-8. PMC: 4522326. DOI: 10.1016/j.cardfail.2015.04.004. View

10.

Huynh Q, Negishi K, Blizzard L, Saito M, DE Pasquale C, Hare J . Mild cognitive impairment predicts death and readmission within 30days of discharge for heart failure. Int J Cardiol. 2016; 221:212-7. DOI: 10.1016/j.ijcard.2016.07.074. View

11.

Teng E, Chui H . The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry. 1987; 48(8):314-8. View

12.

Huijts M, van Oostenbrugge R, Duits A, Burkard T, Muzzarelli S, Maeder M . Cognitive impairment in heart failure: results from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF) randomized trial. Eur J Heart Fail. 2013; 15(6):699-707. DOI: 10.1093/eurjhf/hft020. View

13.

Benjamin E, Blaha M, Chiuve S, Cushman M, Das S, Deo R . Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017; 135(10):e146-e603. PMC: 5408160. DOI: 10.1161/CIR.0000000000000485. View

14.

Shea J, Beers B, McDonald V, Quistberg D, Ravenell K, Asch D . Assessing health literacy in African American and Caucasian adults: disparities in rapid estimate of adult literacy in medicine (REALM) scores. Fam Med. 2004; 36(8):575-81. View

15.

Heart Failure Society Of America . Nonpharmacologic management and health care maintenance in patients with chronic heart failure. J Card Fail. 2006; 12(1):e29-37. DOI: 10.1016/j.cardfail.2005.11.011. View

16.

Dolansky M, Hawkins M, Schaefer J, Gunstad J, Sattar A, Redle J . Cognitive Function Predicts Risk for Clinically Significant Weight Gain in Adults With Heart Failure. J Cardiovasc Nurs. 2016; 32(6):568-575. PMC: 5413441. DOI: 10.1097/JCN.0000000000000376. View

17.

Cajita M, Cajita T, Han H . Health Literacy and Heart Failure: A Systematic Review. J Cardiovasc Nurs. 2015; 31(2):121-30. PMC: 4577469. DOI: 10.1097/JCN.0000000000000229. View

18.

Jovanic M, Zdravkovic M, Stanisavljevic D, Jovic Vranes A . Exploring the Importance of Health Literacy for the Quality of Life in Patients with Heart Failure. Int J Environ Res Public Health. 2018; 15(8). PMC: 6121278. DOI: 10.3390/ijerph15081761. View

19.

McNaughton C, Cawthon C, Kripalani S, Liu D, Storrow A, Roumie C . Health literacy and mortality: a cohort study of patients hospitalized for acute heart failure. J Am Heart Assoc. 2015; 4(5). PMC: 4599411. DOI: 10.1161/JAHA.115.001799. View

20.

Rawson K, Gunstad J, Hughes J, Spitznagel M, Potter V, Waechter D . The METER: a brief, self-administered measure of health literacy. J Gen Intern Med. 2009; 25(1):67-71. PMC: 2811598. DOI: 10.1007/s11606-009-1158-7. View