Heart Failure and Low Health Literacy: Mitigating This Lethal Combination

Nearly 6 million Americans are afflicted with heart failure (HF), with 825 000 new HF cases diagnosed annually,1 incurring direct costs of care that exceed $21 billion. Current estimates of this burden project that by 2030, nearly 8 million Americans will be diagnosed with HF and direct costs will escalate to over $53 billion.2,3 Heart failure ranks high among the most frequent causes of adult hospital admissions4-6; representing the greatest cause of hospital readmission among both medical and surgical patients,7 and, for the Medicare patient population, the single most common reason for hospitalization.8 After hospital discharge, more than 30% of HF patients are readmitted to the hospital or die within 90 days.9,10 Because those who are hospitalized for acute HF have a 3 times greater risk of death compared to those who can be managed in an outpatient setting,11,12 considerable research and reimbursement incentives have been generated to reduce preventable readmissions. Many of the efforts to reduce the toll of HF have examined approaches for reducing rehospitalization by targeting its known risk factors. Although some of these risks (advanced age, medical history of diabetes mellitus, pulmonary or renal disease, sleep apnea, myocardial infarction, coronary artery disease, cardiac valvular disease, cardiomyopathy, and myocarditis) are not amenable to modification, targeting other risk factors such as diet, exercise, obesity, hypertension, and medication adherence has not produced resounding success tales. One of the reasons for this limited success may relate to the complexity of this clinical disorder as well as to the number and range of therapies employed. Another reason relates to the capacity of these patients to provide the self-care that this condition demands. At a minimum, even patients with stable, chronic HF need to be able to manage their salt, fluid, and calorie intake; measure and document their weight; exercise regularly; take prescribed medications; and recognize when to notify their health care provider. Several studies show that low patient health literacy is a significant contributor to the high mortality in patients with acute HF.