Alfabetización en salud y resultados de salud en pacientes muy ancianos con insuficiencia cardiaca / Health literacy and health outcomes in very old patients with heart failure

Introducción y objetivos: La alfabetización en salud (AS) se ha asociado con menor mortalidad en pacientes con insuficiencia cardiaca (IC) relativamente jóvenes y de alto nivel educativo en Estados Unidos. Este estudio evalúa la asociación de la AS con el conocimiento de la enfermedad, el autocuidado y la mortalidad por cualquier causa en pacientes muy ancianos con muy bajo nivel educativo. Métodos: Estudio prospectivo con 556 pacientes (media de edad, 85 años) con mucha comorbilidad admitidos por IC en las unidades geriátricas de 6 hospitales españoles. El 74% de los pacientes tenían estudios inferiores a los primarios y el 71%, función sistólica conservada. La AS se valoró con el cuestionario Short Assessment of Health Literacy for Spanish-speaking Adults; el conocimiento sobre la IC, con el cuestionario de DeWalt, y el autocuidado, con la European Heart Failure Self-Care Behaviour Scale. Resultados: El conocimiento sobre la IC aumenta con la AS; comparado con el tercil inferior de AS, el coeficiente beta multivariado (IC95%) de conocimiento sobre la IC fue 0,60 (0,01-1,19) en el segundo tercil y 0,87 (0,24-1,50) en el tercil superior (p de tendencia = 0,008). Sin embargo, la AS no se asoció con el autocuidado de la IC. En los 12 meses de seguimiento hubo 189 muertes. Comparado con el tercil inferior de AS, la HR multivariable (IC95%) de mortalidad fue 0,84 (0,56-1,27) en el segundo tercil y 0,99 (0,65-1,51) en el tercil superior (p de tendencia = 0,969). Conclusiones: No se observó asociación entre la AS y la mortalidad a los 12 meses. Esto puede explicarse en parte por la falta de asociación entre AS y autocuidado (AU)

Introduction and objectives: Health literacy (HL) has been associated with lower mortality in heart failure (HF). However, the results of previous studies may not be generalizable because the research was conducted in relatively young and highly-educated patients in United States settings. This study assessed the association of HL with disease knowledge, self-care, and all-cause mortality among very old patients, with a very low educational level. Methods: This prospective study was performed in 556 patients (mean age, 85 years), with high comorbidity, admitted for HF to the geriatric acute-care unit of 6 hospitals in Spain. About 74% of patients had less than primary education and 71% had preserved systolic function. Health literacy was assessed with the Short Assessment of Health Literacy for Spanish-speaking Adults questionnaire, knowledge of HF with the DeWalt questionnaire, and HF self-care with the European Heart Failure Self-Care Behaviour Scale. Results: Disease knowledge progressively increased with HL; compared with being in the lowest (worse) tertile of HL, the multivariable beta coefficient (95%CI) of the HF knowledge score was 0.60 (0.01-1.19) in the second tertile and 0.87 (0.24-1.50) in the highest tertile, P-trend = .008. However, no association was found between HL and HF self-care. During the 12 months of follow-up, there were 189 deaths. Compared with being in the lowest tertile of HL, the multivariable HR (95%CI) of mortality was 0.84 (0.56-1.27) in the second tertile and 0.99 (0.65-1.51) in the highest tertile, P-trend = .969. Conclusions: No association was found between HL and 12-month mortality. This could be partly due to the lack of a link between HL and self-care (AU)

Health Literacy and Health Outcomes in Very Old Patients With Heart Failure.

INTRODUCTION AND OBJECTIVES: Health literacy (HL) has been associated with lower mortality in heart failure (HF). However, the results of previous studies may not be generalizable because the research was conducted in relatively young and highly-educated patients in United States settings. This study assessed the association of HL with disease knowledge, self-care, and all-cause mortality among very old patients, with a very low educational level. METHODS: This prospective study was performed in 556 patients (mean age, 85 years), with high comorbidity, admitted for HF to the geriatric acute-care unit of 6 hospitals in Spain. About 74% of patients had less than primary education and 71% had preserved systolic function. Health literacy was assessed with the Short Assessment of Health Literacy for Spanish-speaking Adults questionnaire, knowledge of HF with the DeWalt questionnaire, and HF self-care with the European Heart Failure Self-Care Behaviour Scale. RESULTS: Disease knowledge progressively increased with HL; compared with being in the lowest (worse) tertile of HL, the multivariable beta coefficient (95%CI) of the HF knowledge score was 0.60 (0.01-1.19) in the second tertile and 0.87 (0.24-1.50) in the highest tertile, P-trend = .008. However, no association was found between HL and HF self-care. During the 12 months of follow-up, there were 189 deaths. Compared with being in the lowest tertile of HL, the multivariable HR (95%CI) of mortality was 0.84 (0.56-1.27) in the second tertile and 0.99 (0.65-1.51) in the highest tertile, P-trend = .969. CONCLUSIONS: No association was found between HL and 12-month mortality. This could be partly due to the lack of a link between HL and self-care.