Abstract
Background: Cognitive impairment and limited health literacy are prevalent among patients with heart failure, particularly those residing in rural areas, and are linked to poor health outcomes. Little is known about the intricate relationships among cognitive function, health literacy, and rehospitalization and death in rural patients with heart failure. Objectives: To determine the relationships among cognitive function, health literacy, and cardiac event-free survival (ie, heart failure hospitalizations and cardiac mortality) in rural patients with heart failure. Methods: This was a secondary data analysis of a randomized controlled trial of 573 rural patients with heart failure. Cognitive function was measured using the Mini-Cog test. Health literacy was measured by the Short Test of Functional Health Literacy in Adults. Cardiac event-free survival was followed for 2 years. Survival analyses (ie, Kaplan-Meier plots with log-rank test and Cox regression) were used. Results: Cognitive impairment was associated with limited health literacy. Cognitive impairment and limited health literacy predicted worse cardiac event-free survival (P<.05). Patients with both cognitive impairment and limited health literacy had a 2.24 times higher risk of experiencing a cardiac event compared to those without cognitive impairment and with adequate health literacy (P<.001). Conclusions: Patients with cognitive impairment and limited health literacy were at the highest risk of experiencing a cardiac event. It is important to screen rural patients with heart failure for cognitive impairment and limited health literacy. Interventions to improve outcomes need to be developed to target rural patients who have heart failure with cognitive impairment and limited health literacy.
| Original language | English |
|---|---|
| Article number | e12919 |
| Journal | Journal of Rural Health |
| Volume | 41 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2025 |
Bibliographical note
Publisher Copyright:© 2025 National Rural Health Association.
Funding
This study was supported by funding from the National Heart, Lung, and Blood Institute and the National Institute of Nursing Research (NINR): 5R01HL83176\u20105 (K. Dracup, principal investigator [PI]), R01 NR020478\u201002 (J.R. Wu, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute, the National Institute of Nursing Research, or the National Institutes of Health. This study was supported by funding from the National Heart, Lung, and Blood Institute and the National Institute of Nursing Research (NINR): 5R01HL83176-5 (K. Dracup, principal investigator [PI]), R01 NR020478-02 (J.R. Wu, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute, the National Institute of Nursing Research, or the National Institutes of Health.
| Funders | Funder number |
|---|---|
| National Heart, Lung, and Blood Institute Family Blood Pressure Program | |
| National Institutes of Health (NIH) | |
| National Institute of Health National Institute of Nursing Research | R01 NR020478‐02, 5R01HL83176‐5 |
Keywords
- cognitive impairment
- death
- health literacy
- heart failure
- hospitalization
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
