Knowledge Is Power for Patients With Heart Failure

Death rates may be higher for those lacking clear grasp of doctor's instructions, study suggests

Wednesday, April 29, 2015

WEDNESDAY, April 29, 2015 (HealthDay News) -- Heart failure patients may be more likely to die following hospitalization if they have a hard time reading, understanding and using health information, a new study suggests.

People with low "health literacy" who wound up in the hospital with acute heart failure ran a 34 percent greater risk of dying during the study period if they didn't grasp the information that doctors and nurses provided them about their condition, said lead author Dr. Candace McNaughton. She is an assistant professor of emergency medicine at Vanderbilt University Medical Center in Nashville, Tenn.

"Patients with lower health literacy skills may have difficulty communicating with health care providers, navigating the health care system, recognizing signs of health decline, and knowing when and who to contact when they do become ill," McNaughton said.

For example, heart failure patients face a "bewildering" array of medical instructions when being discharged from the hospital, she said. They often have to take a fistful of medications every day, and are asked to make major changes to their diet and lifestyle.

"If a patient doesn't understand what or how to best take their medications, their symptoms may get worse and they may need to be hospitalized to treat their symptoms," McNaughton said. "This can become a cycle, in and out of the hospital, that can sometimes be difficult to break."

For the study, researchers tracked deaths among more than 1,300 patients who had been hospitalized for acute heart failure between 2010 and 2013. All the patients filled out a questionnaire that rated their health literacy, asking about their confidence in filling out medical forms independently and their ability to read and understand medical information.

Heart failure occurs when the heart's pumping action is weakened and it can't supply enough blood to the body's organs. The condition affects more than 5 million Americans over the age of 20 and is a frequent cause of hospitalization, according to the American Heart Association.

In the study, heart failure patients with low health literacy -- scoring below 10 on a scale from 3 to 15 -- were one-third more likely to have died during the average 21-month follow-up period than patients with higher health knowledge.

Those with low health literacy tended to be older, male, covered by government health insurance and high school dropouts, the researchers found.

But even people "who are highly literate or highly educated in other areas may have difficulty reading and understanding health care information," McNaughton noted.

Dr. Mariell Jessup is medical director of the Penn Heart and Vascular Center at the Hospital of the University of Pennsylvania, in Philadelphia. She said it "makes common sense that people who may have difficulty following instructions or don't understand the reasons behind the instructions would not do as well as those who can."

"There are a number of different lifestyle changes you have to make if you're going to manage yourself with heart failure," added Jessup, who's also a spokeswoman for the American Heart Association. "It's not easy to make these changes. Managing a complex medical regimen is not always easy. A lot of the medications you may have to take three or four times a day."

McNaughton said patients can help themselves by having a family member or an advocate with them during doctor visits. And they need to take an active role in discussing their condition with their doctor, she said.

"Patients can repeat, in their own words, back to their providers medication regimens or plan of care," McNaughton said. "This can help clear up confusions and bring up questions."

They also should feel free to raise a hand if they're becoming overwhelmed, or simply aren't getting it, she added.

"I really appreciate it when a patient tells me they don't understand," McNaughton said. "That helps focus the conversation, and I can hone in on what they are having a hard time grasping."

Physicians can help, too, by simplifying medical instructions and providing tools like pill boxes that help make a medical regimen more manageable, Jessup said.

Doctors also should be ready to pare down instructions to the basic essentials, so patients will be able to keep up with the tasks that matter most.

"Patients will ask, 'Which of these rules you're giving me do I absolutely have to follow?'" Jessup said. "They are being totally honest and realistic about what they can manage. Clinicians need to hear that and adjust to make the regimen as easy as possible."

The findings were published in the April 29 issue of the Journal of the American Heart Association.

SOURCES: Candace McNaughton, M.D., MPH, assistant professor, emergency medicine, Vanderbilt University Medical Center, Nashville, Tenn.; Mariell Jessup, M.D., medical director, Penn Heart and Vascular Center, Hospital of the University of Pennsylvania, Philadelphia; April 29, 2015, Journal of the American Heart Association

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