Health Literacy Predicts Morbidity and Mortality in Rural Patients with Heart Failure

Debra K. Moser, Susan Robinson, Martha J. Biddle, Michele M. Pelter, Thomas S. Nesbitt, Jeffery Southard, Lawton Cooper, Kathleen Dracup

Research output: Contribution to journalArticlepeer-review

78 Scopus citations


Background Patients hospitalized with heart failure are often readmitted. Health literacy may play a substantial role in the high rate of readmissions. The purpose of this study was to examine the association of health literacy with the composite end point of heart failure readmission rates and all-cause mortality in patients with heart failure living in rural areas. Methods and Results Rural adults (n = 575), hospitalized for heart failure within the past 6 months, completed the Short Test of Functional Health Literacy in Adults (STOFHLA) to measure health literacy and were followed for ≥2 years. The percentage of patients with the end point of heart failure readmission or all-cause death was different (P =.001) among the 3 STOFHLA score levels. Unadjusted analysis revealed that patients with inadequate and marginal health literacy were 1.94 (95% confidence interval [CI] 1.43-2.63; P <.001) times, and 1.91 (95% CI 1.36-2.67; P <.001) times, respectively, more likely to experience the outcome. After adjustment for covariates, health literacy remained a predictor of outcomes. Of the other covariates, worse functional class, higher comorbidity burden, and higher depression score predicted worse outcomes. Conclusions Inadequate or marginal health literacy is a risk factor for heart failure rehospitalization or all-cause mortality among rural patients with heart failure.

Original languageEnglish
Pages (from-to)612-618
Number of pages7
JournalJournal of Cardiac Failure
Issue number8
StatePublished - Aug 1 2015

Bibliographical note

Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.


  • Health literacy
  • heart failure
  • rural

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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