1
|
Nair D, Schildcrout JS, Shi Y, Trochez R, Nwosu S, Bell SP, Mixon AS, Welch SA, Goggins K, Bachmann JM, Vasilevskis EE, Cavanaugh KL, Rothman RL, Kripalani SB. Patient-reported predictors of postdischarge mortality after cardiac hospitalization. J Hosp Med 2024; 19:475-485. [PMID: 38560772 PMCID: PMC11147709 DOI: 10.1002/jhm.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Adults hospitalized for cardiovascular events are at high risk for postdischarge mortality. Screening of psychosocial risk is prioritized by the Joint Commission. We tested whether key patient-reported psychosocial and behavioral measures could predict posthospitalization mortality in a cohort of adults hospitalized for a cardiovascular event. METHODS We conducted a prospective cohort study to test the prognostic utility of validated patient-reported measures, including health literacy, social support, health behaviors and disease management, and socioeconomic status. Cox survival analyses of mortality were conducted over a median of 3.5 years. RESULTS Among 2977 adults hospitalized for either acute coronary syndrome or acute decompensated heart failure, the mean age was 53 years, and 60% were male. After adjusting for demographic, clinical, and other psychosocial factors, mortality risk was greatest among patients who reported being unemployed (hazard ratio [HR]: 1.99, 95% confidence interval [CI]): 1.30-3.06), retired (HR: 2.14, 95% CI: 1.60-2.87), or unable to work due to disability (HR: 2.36, 95% CI: 1.73-3.21), as compared to those who were employed. Patient-reported perceived health competence (PHCS-2) and exercise frequency were also associated with mortality risk after adjusting for all other variables (HR: 0.86, 95% CI: 0.73-1.00 per four-point increase in PHCS-2; HR: 0.86, 95% CI: 0.77-0.96 per 3-day increase in exercise frequency, respectively). CONCLUSIONS Patient-reported measures of employment status, perceived health competence, and exercise frequency independently predict mortality after a cardiac hospitalization. Incorporating these brief, valid measures into hospital-based screening may help with prognostication and targeting patients for resources during post-discharge transitions of care.
Collapse
Affiliation(s)
- Devika Nair
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan S Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yaping Shi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ricardo Trochez
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sam Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan P Bell
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amanda S Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Sarah A Welch
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathryn Goggins
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin M Bachmann
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Kerri L Cavanaugh
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Russell L Rothman
- Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sunil B Kripalani
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, VUMC, Nashville, Tennessee, USA
| |
Collapse
|
2
|
Nair D, Schildcrout JS, Shi Y, Trochez R, Nwosu S, Bell SP, Mixon AS, Welch SA, Goggins K, Bachmann JM, Vasilevskis EE, Cavanaugh KL, Rothman RL, Kripalani SB. Patient-reported predictors of post-discharge mortality after cardiac hospitalization. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.02.23296460. [PMID: 37873096 PMCID: PMC10593012 DOI: 10.1101/2023.10.02.23296460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Adults hospitalized for cardiovascular events are at high risk for post-discharge mortality. Hospital-based screening of health-related psychosocial risk factors is now prioritized by the Joint Commission and the National Quality Forum to achieve equitable, high-quality care. We tested our hypothesis that key patient-reported psychosocial and behavioral measures could predict post-hospitalization mortality in a cohort of adults hospitalized for a cardiovascular event. Methods This was a prospective cohort of adults hospitalized at Vanderbilt University Medical Center. Validated patient-reported measures of health literacy, social support, disease self-management, and socioeconomic status were used as predictors of interest. Cox survival analyses of mortality were conducted over a median 3.5-year follow-up (range: 1.25 - 5.5 years). Results Among 2,977 adults, 1,874 (63%) were hospitalized for acute coronary syndrome and 1,103 (37%) were hospitalized for acute decompensated heart failure; 60% were male; and the mean age was 53 years. After adjusting for demographic, clinical, and other psychosocial factors, mortality risk was greatest among patients who reported being unable to work due to disability (Hazard Ratio (HR) 2.36, 95% Confidence Interval (CI): 1.73-3.21), who were retired (HR 2.14, 95% CI 1.60-2.87), and who reported unemployment (HR 1.99, 95% CI 1.30-3.06) as compared to those who were employed. Patient-reported measures of disease self-management, perceived health competence and exercise frequency, were also associated with mortality risk after full covariate adjustment (HR 0.86, 95% CI 0.73-1.00 per four-point increase), (HR 0.86, 95% CI 0.77-0.96 per three-day change), respectively. Conclusions Patient-reported measures of employment status independently predict post-discharge mortality after a cardiac hospitalization. Measure of disease self-management also have prognostic modest utility. Hospital-based screening of psychosocial risk is increasingly prioritized in legislative policy. Incorporating brief, valid measures of employment status and disease self-management factors may help target patients for psychosocial, financial, and rehabilitative resources during post-discharge transitions of care.
Collapse
|
3
|
Salgado R, Paulo N, Zufferey A, Bucher CO. Patient's learning needs and self-efficacy level after percutaneous coronary intervention: A descriptive study. J Clin Nurs 2023; 32:6415-6426. [PMID: 36823713 DOI: 10.1111/jocn.16656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/27/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
AIMS AND OBJECTIVES Identify and compare learning needs, levels of self-efficacy and their association among inpatients and outpatients of a cardiac care unit with coronary heart disease who have undergone percutaneous coronary intervention (PCI) in a Swiss university hospital. BACKGROUND After primary PCI, 42% of patients will suffer a recurrent ischemic cardiovascular event. Although adherence to therapeutic regimen contributes to prevent recurrence, patient adherence remains low. To strengthen it, learning needs and self-efficacy must be considered when developing effective therapeutic patient education (TPE). METHODS Learning needs and self-efficacy were assessed using the Cardiac Patient Learning Needs Inventory (CPLNI) and the Cardiac Self-Efficacy Scale among inpatients and outpatients. The STROBE checklist for cross-sectional studies was used in reporting this study. RESULTS Ninety-three patients participated in the study with a participation rate of 73.9%. The CPLNI median total score was significantly higher in inpatients than in outpatients: 4.23 (3.82, 4.64) versus 3.67 (3.33, 4.09), p < .001. In both units, participants declared that the most important need was related to 'anatomy and physiology' of the heart. Despite the high score, the least important need was about 'physical activity' for inpatients and 'miscellaneous information' for outpatients. No statistically significant differences were found among patients from both units regarding their self-efficacy level. CONCLUSIONS This study shows that after PCI, patients have high learning needs and moderate levels of self-efficacy that require addressing. RELEVANCE TO CLINICAL PRACTICE Patient's individual learning needs and self-efficacy level must be assessed prior/after PCI. A tailored TPE that considers individual learning needs and self-efficacy is recommended as a preventative measure to reduce recurrent ischemic cardiovascular events. Nurses can play a key role in this process. NO PATIENT OR PUBLIC CONTRIBUTION For feasibility reasons, patients and public were not involved in the design, conduct, reporting or dissemination plans of this research.
Collapse
Affiliation(s)
- Ricardo Salgado
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Faculty of Biology and Medicine, Institute of Higher Education and Research in Health Care (IUFRS), Lausanne, Switzerland
| | - Natércia Paulo
- Faculty of Biology and Medicine, Institute of Higher Education and Research in Health Care (IUFRS), Lausanne, Switzerland
| | - Arnaud Zufferey
- Cardiology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Claudia Ortoleva Bucher
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| |
Collapse
|
4
|
Koch P, Kersten JF, Nienhaus A. Monitoring a cohort of trainees: changes over time and associations between health literacy, health behaviour and health. J Occup Med Toxicol 2023; 18:18. [PMID: 37644517 PMCID: PMC10466870 DOI: 10.1186/s12995-023-00387-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND For many entrants, the initial stages of professional training are a challenge. Demands at work can lead to new physical and psychological stress, as well as new social requirements. These new requirements can influence the health behaviour and the state of health of young employees. In recent years, there have been many studies on health literacy (HL). HL represents resources and potentials that allow individuals to achieve improved control of their health and of factors that influence health. Thus, HL can influence both well-being and health. In the present study, the health of trainees in different branches (health and welfare services, office, sales, technology) is monitored over time ending in the period of the COVID-19 pandemic. Furthermore, the association between health literacy and health or health behaviour has been examined. METHODS In 2017/18, a baseline survey (T0) was performed on trainees in various sectors (office, sales, teaching, nursing and social welfare, engineering, hairdressers), who had been contacted through vocational colleges in four federal states in north Germany. The trainees were surveyed again in the in the first year after training in 2021 (T3). Demographic data were collected, as well as information on health literacy (HLS-EU-16), health behaviour (physical exercise, nutrition, smoking and alcohol) and state of health (BMI, psychological well-being and subjective state of health). Recognition, satisfaction at work and thoughts of leaving the profession were surveyed with the Copenhagen Psychosocial Questionnaire (COPSOQ). Statistical analysis was performed with tests for paired samples and multivariate regression analysis in SPSS 26. RESULTS 129 data sets were evaluated, with a follow-up rate of 10.2%. 85% of the trainees were female. The mean age at follow-up was 25.6 years. 56% were employed in the health service or social welfare. 35% worked in the office, sales or engineering. At T3, 47% of the employees exhibited limited health literacy, 67% low levels of exercise and 30% risky alcohol use. 42% exhibited overweight and 42% poor psychological well-being. An association between health literacy (HL) and psychological well-being was only observed in cross-section (HL inadequate vs. HL adequate OR: 3.2 95% CI: 1.07-9.49, p = 0.037). The odds ratio relative to subjective state of health was also increased, although the association was not statistically significant (HL inadequate vs. HL adequate OR: 2.7 95% CI: 0.72-9.78, p = 0.143). In the sector for health service and social welfare, there was statistically significant deterioration over time in all COPSOQ variables (recognition, satisfaction at work, thoughts of leaving the profession). CONCLUSIONS For a group of trainees in the first year of work during the covid-19 epidemic, the present findings show that there is a need to prevent risky health behaviour, overweight and poor psychological well-being. Health literacy was shown to be a modifiable parameter, that apparently is associated in cross - but not in longitudinal section with the health of young employees. It would appear to be reasonable to modify developing health literacy in the setting of work and school.
Collapse
Affiliation(s)
- Peter Koch
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Jan Felix Kersten
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Albert Nienhaus
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department for Occupational Medicine, Hazardous Substances and Health Sciences (AGG), German Social Accident Insurance for the Health and Welfare Services (BGW), Hamburg, Germany
| |
Collapse
|
5
|
Hirooka N, Kusano T, Kinoshita S, Aoyagi R. Association of Health Literacy With the Prevalence of Cardiovascular Diseases and Their Risk Factors Among Older Japanese Health Management Specialists. Gerontol Geriatr Med 2023; 9:23337214231189059. [PMID: 37492034 PMCID: PMC10363860 DOI: 10.1177/23337214231189059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023] Open
Abstract
In this study, we aimed to determine the association between health literacy and the development of cardiovascular diseases (CVDs), among an older population. This cross-sectional study was conducted among Japanese health management specialists (N = 593). Higher levels (communicative and critical) of health literacy and CVD risk factors (diabetes mellitus, hypertension, dyslipidemia, and obesity) were measured. The mean patient age was 71.3 years. Logistic regression analyses showed statistically significant associations between higher levels of health literacy and the prevalence of CVDs (β coefficient = -.091, p < .05) and metabolic risk factors (β coefficient = -.084, p < .01). There was a statistically significant association between health literacy and the count of CVDs (and its risk factors) (β coefficients of Poisson regression = -.036, p < .05). The results show health literacy to be fundamentally related to low prevalence of cardiovascular diseases and their associated metabolic risk factors.
Collapse
|
6
|
Huy LD, Truong NLT, Hoang NY, Nguyen NTH, Nguyen TTP, Dang LT, Hsu YHE, Huang CC, Chang YM, Shih CL, Carbone ET, Yang SH, Duong TV. Insight into global research on health literacy and heart diseases: A bibliometric analysis. Front Cardiovasc Med 2022; 9:1012531. [PMID: 36505390 PMCID: PMC9729531 DOI: 10.3389/fcvm.2022.1012531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Health literacy (HL) has shown its important role on reducing the burden of heart diseases. However, no study has provided a comprehensive worldwide view of the data regarding HL and heart diseases. The study aimed to provide insight into: (1) the intellectual structure, (2) research trends, and (3) research gaps on HL and heart diseases; and (4) to explore HL scales commonly utilized in heart studies. Materials and methods Studies related to HL and heart diseases were retrieved from Web of Science, Scopus, and PubMed. All publications published between 2000 and 2021 were included after conducting keyword searches on "heart diseases" in general or on specific types of heart diseases (e.g., "heart failure") and "health literacy". Bibliometric analyses were carried out using the Bibliometrix R package and VOSviewer 1.6.14. Findings A total of 388 original research articles and reviews on HL and heart diseases were included in our study. The studies were primarily conducted in the United States and developed countries. A total of 337 studies (86.9%) focused on heart failure (200 studies, 51.5%) and ischemic heart diseases (137 studies, 35.3%). Sixty-two studies (16.0%) focused on other heart diseases (e.g., valvular diseases and rheumatic heart diseases). The number of interventional studies was limited (52 studies, 13.4%) and fluctuated from 2000 to 2021. The most common questionnaires measuring health literacy among patients with heart diseases were the Test of Functional Health Literacy in Adults (TOFHLA), Short Test of Functional Health Literacy in Adults (STOFHLA), and Brief Health Literacy Screen (BHLS). Use of the eHealth Literacy Scale (eHEALS) has become the latest trend among patients with heart diseases. Conclusion Health literacy and heart diseases were most often studied in the United States and developed countries. Several HL tools were used; eHEALS has been lately used in this field. These findings suggest the need to conduct more empirical studies on HL and heart diseases in different settings (e.g., developing or poor countries) and with different types of heart diseases (e.g., valvular and rheumatic disorders). Additionally, it is necessary to develop heart disease-specified HL scales for research and practice.
Collapse
Affiliation(s)
- Le Duc Huy
- Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, Vietnam
| | - Nguyen L. T. Truong
- School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam,Pharmacy Department, Thong Nhat Hospital, Ho Chi Minh City, Vietnam
| | - Nhi Y. Hoang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Nhi Thi Hong Nguyen
- Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, Vietnam,School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Thao T. P. Nguyen
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Loan T. Dang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan,Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam
| | - Yi-Hsin Elsa Hsu
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan,Executive Master Program of Business Administration in Biotechnology, College of Management, Taipei Medical University, Taipei, Taiwan,International Ph.D. Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Chung-Chien Huang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan,International Ph.D. Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan,Department of Long-Term Care and School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan,School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Yao-Mao Chang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan,Research Center of Health and Welfare Policy, Taipei Medical University, Taipei, Taiwan
| | | | - Elena T. Carbone
- Department of Nutrition, University of Massachusetts, Amherst, MA, United States
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan,Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan,Research Center of Geriatric Nutrition, Taipei Medical University, Taipei, Taiwan,*Correspondence: Shwu-Huey Yang,
| | - Tuyen V. Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan,International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Tuyen V. Duong,
| |
Collapse
|
7
|
Morrow EL, Duff MC, Mayberry LS. Mediators, Moderators, and Covariates: Matching Analysis Approach for Improved Precision in Cognitive-Communication Rehabilitation Research. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4159-4171. [PMID: 36306506 PMCID: PMC9940892 DOI: 10.1044/2022_jslhr-21-00551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The dual goals of this tutorial are (a) to increase awareness and use of mediation and moderation models in cognitive-communication rehabilitation research by describing options, benefits, and attainable analytic approaches for researchers with limited resources and sample sizes and (b) to describe how these findings may be interpreted for clinicians consuming research to inform clinical care. METHOD We highlight key insights from the social sciences literature pointing to the risks of common approaches to linear modeling, which may slow progress in clinical-translational research and reduce the clinical utility of our work. We discuss the potential of mediation and moderation analyses to reduce the research-to-practice gap and describe how researchers may begin to implement these models, even in smaller sample sizes. We discuss how these preliminary analyses can help focus resources for larger trials to fully encapsulate the heterogeneity of individuals with cognitive-communication disorders. RESULTS In rehabilitation research, we study groups, but we use the findings from those studies to treat individuals. The most functional clinical research is about more than establishing only whether a given effect exists for an "average person" in the group of interest. It is critical to understand the active ingredients and mechanisms of action by which a given treatment works (mediation) and to know which circumstances, contexts, or individual characteristics might make that treatment most beneficial (moderation). CONCLUSIONS Increased adoption of mediation and moderation approaches, executed in appropriate steps, could accelerate progress in cognitive-communication rehabilitation research and lead to the development of targeted treatments that work for more clients. In a field that has made limited progress in developing successful interventions for the last several decades, it is critical that we harness new approaches to advance clinical-translational research results for complex, heterogeneous groups with cognitive-communication disorders.
Collapse
Affiliation(s)
- Emily L. Morrow
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa C. Duff
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Lindsay S. Mayberry
- Department of Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
8
|
Gomez R, Andrey JL, Puerto JL, Romero SP, Pedrosa MJ, Rosety-Rodriguez M, Gomez F. Health literacy and prognosis of heart failure: a prospective propensity-matched study in the community. Eur J Cardiovasc Nurs 2022; 22:282-290. [PMID: 35849049 DOI: 10.1093/eurjcn/zvac045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/14/2022]
Abstract
AIMS Health literacy (HL), the ability to obtain and understand health information, is critical to self-care in chronic disorders. A low HL is common among these patients and has been associated with a worse prognosis. Nevertheless, the relationship between HL and the prognosis of heart failure (HF) with reduced (HFrEF) vs. preserved (HFpEF) ejection fraction remains unsettled. To analyse the relationship between HL and the prognosis of patients with incident HFrEF and HFpEF. METHODS AND RESULTS Prospective study over 10 years (2010-19) on 6444 patients diagnosed with incident HF. The main outcomes were mortality, hospitalizations, and visits to emergency services. The independent relationship between HL and the prognosis, stratifying patients for cardiovascular comorbidity after propensity score-matching was analysed.After matching 5355 HF patients, 1785 with low HL (874 with HFrEF and 911 with HFpEF) vs. 3570 with adequate HL (1748 with HFrEF and 1822 with HFpEF), during a median follow-up of 5.41 years, 3874 patients died (72.3%) and 3699 patients were hospitalized (69.1%). After adjustment for potential confounders, an adequate HL was associated with a lower all-cause and cardiovascular mortality, less hospitalizations, and less 30-day readmissions [relative risk (RR) for HF <0.72 (0.66-0.86), RR for HFrEF <0.69 (0.63-0.95), and RR for HFpEF <0.62 (0.55-0.88), P < 0.001 in all cases], both for patients with HFrEF and HFpEF. Analyses of recurrent hospitalizations gave larger HL effects than time-to-first-event analyses. CONCLUSIONS In this propensity-matched study, a low HL is associated with a worse prognosis of patients with incident HFrEF and HFpEF.
Collapse
Affiliation(s)
- Rocio Gomez
- Department of Medicine, Hospital Universitario Puerto Real, University of Cadiz, School of Medicine, Cadiz, Spain
| | - Jose L Andrey
- Department of Medicine, Hospital Universitario Puerto Real, University of Cadiz, School of Medicine, Cadiz, Spain
| | - Jose L Puerto
- Department of Medicine, Hospital Universitario Puerto Real, University of Cadiz, School of Medicine, Cadiz, Spain
| | - Sotero P Romero
- Department of Medicine, Hospital Universitario Puerto Real, University of Cadiz, School of Medicine, Cadiz, Spain
| | - Maria J Pedrosa
- Department of Medicine, Hospital Universitario Puerto Real, University of Cadiz, School of Medicine, Cadiz, Spain
| | - Manuel Rosety-Rodriguez
- Department of Medicine, Hospital Universitario Puerto Real, University of Cadiz, School of Medicine, Cadiz, Spain
| | - Francisco Gomez
- Department of Medicine, Hospital Universitario Puerto Real, University of Cadiz, School of Medicine, Cadiz, Spain
| |
Collapse
|
9
|
Beauchamp A, Talevski J, Nicholls SJ, Wong Shee A, Martin C, Van Gaal W, Oqueli E, Ananthapavan J, Sharma L, O'Neil A, Brennan-Olsen SL, Jessup RL. Health literacy and long-term health outcomes following myocardial infarction: protocol for a multicentre, prospective cohort study (ENHEARTEN study). BMJ Open 2022; 12:e060480. [PMID: 35523501 PMCID: PMC9083432 DOI: 10.1136/bmjopen-2021-060480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Low health literacy is common in people with cardiovascular disease and may be one factor that affects an individual's ability to maintain secondary prevention health behaviours following myocardial infarction (MI). However, little is known about the association between health literacy and longer-term health outcomes in people with MI. The ENhancing HEAlth literacy in secondary pRevenTion of cardiac evENts (ENHEARTEN) study aims to examine the relationship between health literacy and a number of health outcomes (including healthcare costs) in a cohort of patients following their first MI. Findings may provide evidence for the significance of health literacy as a predictor of long-term cardiac outcomes. METHODS AND ANALYSIS ENHEARTEN is a multicentre, prospective observational study in a convenience sample of adults (aged >18 years) with their first MI. A total of 450 patients will be recruited over 2 years across two metropolitan health services and one rural/regional health service in Victoria, Australia. The primary outcome of this study will be all-cause, unplanned hospital admissions within 6 months of index admission. Secondary outcomes include cardiac-related hospital admissions up to 24 months post-MI, emergency department presentations, health-related quality of life, mortality, cardiac rehabilitation attendance and healthcare costs. Health literacy will be observed as a predictor variable and will be determined using the 12-item version of the European Health Literacy Survey (HLS-Q12). ETHICS AND DISSEMINATION Ethics approval for this study has been received from the relevant human research ethics committee (HREC) at each of the participating health services (lead site Monash Health HREC; approval number: RES-21-0000-242A) and Services Australia HREC (reference number: RMS1672). Informed written consent will be sought from all participants. Study results will be published in peer-reviewed journals and collated in reports for participating health services and participants. TRIAL REGISTRATION NUMBER ACTRN12621001224819.
Collapse
Affiliation(s)
- Alison Beauchamp
- School of Rural Health, Monash University, Warragul, Victoria, Australia
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jason Talevski
- School of Rural Health, Monash University, Warragul, Victoria, Australia
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Anna Wong Shee
- Allied Health, Ballarat Health Services - Grampians Health, Ballarat, Victoria, Australia
- Deakin Rural Health, Deakin University, Ballarat, Victoria, Australia
| | - Catherine Martin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Data Science and AI, Monash University, Melbourne, Victoria, Australia
| | - William Van Gaal
- Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Cardiology, The Northern Hospital, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- School of Medicine, Deakin University, Burwood, Victoria, Australia
- Cardiology, Ballarat Health Services - Grampians Health, Ballarat, Vic, Australia
| | - Jaithri Ananthapavan
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Laveena Sharma
- School of Rural Health, Monash University, Warragul, Victoria, Australia
- Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Adrienne O'Neil
- Institute for Mental and Physical Health and Clinical Training, Food & Mood Centre, Deakin University, Geelong, Victoria, 3220
| | - Sharon Lee Brennan-Olsen
- School of Health and Social Development, Deakin University - Geelong Waterfront Campus, Geelong, Victoria, Australia
| | - Rebecca Leigh Jessup
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Staying Well Programs, Northern Health, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Katsuragawa S, Goto A, Tsurutani Y, Fukuma S, Inoue K. No Healthcare Utilization and Death. J Gen Intern Med 2022; 37:1648-1657. [PMID: 34590212 PMCID: PMC9130427 DOI: 10.1007/s11606-021-07138-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND An inappropriately low frequency of healthcare utilization has been reported to be associated with poor control of chronic diseases, accelerating healthcare disparities. However, the evidence is limited regarding the association between no healthcare utilization and mortality. OBJECTIVES To examine whether individuals without healthcare utilization have the increased risks of mortality among the US general population. DESIGN Prospective cohort study PARTICIPANTS: Adults aged ≥ 20 years (n = 39,067) in the National Health and Nutrition Examination Survey (NHANES)1999-2014 linked to national mortality data through December 2015. MAIN MEASURES The exposure was the number of visits to healthcare providers during the past year (healthcare utilization): none, 1-3 times (referent), 4-9 times, or ≥ 10 times. Cox hazard regression models were employed to estimate the adjusted hazard ratios (aHR) of all-cause, cardiovascular, and cancer mortality adjusting for socio-demographic characteristics and comorbidities. KEY RESULTS During a median follow-up of 7.4 years, participants without visit over the past year showed higher risks of all-cause mortality (aHR [95% CI] = 1.16 [1.04-1.30]) and cardiovascular mortality (aHR [95% CI] = 1.62 [1.28-2.05]) than those who visited the office 1-3 times. We found no evidence of the association between no visit and cancer mortality. The association between no providers' office visit and all-cause mortality was stronger among males (aHR [95% CI] = 1.22 [1.06-1.40]) than females (aHR [95% CI] = 0.97 [0.79-1.19]; p-for-interaction = 0.01) and among uninsured individuals (aHR [95% CI] = 1.22 [0.98-1.51]) than insured individuals (aHR [95% CI] = 1.09 [0.95-1.25]; p-for-interaction = 0.04). CONCLUSION No providers' office visit over a year was associated with increased risks of all-cause and cardiovascular mortality. Further investigations are warranted to identify the underlying reasons for the elevated mortality risks due to no healthcare utilization.
Collapse
Affiliation(s)
- Sho Katsuragawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Yuya Tsurutani
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kosuke Inoue
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA.
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| |
Collapse
|
11
|
Haddadin F, Beydoun H, Sabharwal B, Rzechorzek W, Khandaker M, Munoz Estrella A, Weininger D, Yue B, De La Villa R, Tamis-Holland JE. Differences in Social Hardships in Women and Men with Acute Myocardial Infarction: Impact on 30-Day Readmission. WOMEN'S HEALTH REPORTS 2022; 3:437-442. [PMID: 35559357 PMCID: PMC9081060 DOI: 10.1089/whr.2021.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 11/13/2022]
Abstract
Background: Studies have shown that women with acute myocardial infarction (AMI) have a higher prevalence of unfavorable social variables then men and have a worse outcome. Less is known regarding the impact of these social variables on 30-day readmission after AMI. Materials and Methods: We analyzed adult patients with AMI enrolled in a Quality Improvement Program intended to improve the peri-discharge care of patients with an AMI, and decrease all-cause 30-day unplanned readmissions. We compared clinical and social variables by gender. Multivariate logistic regression, with separate adjustment for clinical and for social variable, was used to measure adjusted odds for readmission by gender. Results: Among 208 patients included in our project 68 (32.7%) were women. Only 30.9% of women were married or had domestic partner at the time of the interview and only 16.2% were employed. Nearly half of women (48.5%) needed help with medical care, and 39.7% of women did not speak English as their first language. These variables were significantly different by gender. Rates of 30-day readmissions were higher in women than men (22.1% vs. 7.8%, p = 0.024). After adjusting for clinical variables this difference by gender in 30-day readmissions remained significant (odds ratio [OR] 3.34 95% confidence interval [CI] 1.1–11.1, p = 0.049). However, when adjusting for social variables, this difference was no longer noted (OR 0.87 95% CI 0.27–2.78, p = 0.822). Conclusion: Women with AMI are more likely than men to have unfavorable social factors that can impact recovery from AMI and women have a higher 30-day readmission rate. The higher 30-day readmissions in women appears to be influenced by these social factors. Health care interventions aimed at reducing 30-day readmission after AMI should focus on eliciting a detailed social history and providing aid for those requiring additional social support at home.
Collapse
Affiliation(s)
- Faris Haddadin
- Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Hassan Beydoun
- Department of Cardiology, University of Arizona COM-Phoenix, Phoenix, Arizona, USA
| | - Basera Sabharwal
- Department of Cardiology, Icahn School of Medicine at Mount Sinai Morningside, New York, New York, USA
| | - Wojciech Rzechorzek
- Department of Cardiovascular Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Mariam Khandaker
- Department of Cardiology, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Alba Munoz Estrella
- Department of Cardiology, Icahn School of Medicine at Mount Sinai Morningside, New York, New York, USA
| | - David Weininger
- Department of Cardiovascular Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Bing Yue
- Department of Cardiology, Icahn School of Medicine at Mount Sinai Morningside, New York, New York, USA
| | | | | |
Collapse
|
12
|
Beauchamp A, Talevski J, Niebauer J, Gutenberg J, Kefalianos E, Mayr B, Sareban M, Kulnik ST. Health literacy interventions for secondary prevention of coronary artery disease: a scoping review. Open Heart 2022; 9:openhrt-2021-001895. [PMID: 35064057 PMCID: PMC8785201 DOI: 10.1136/openhrt-2021-001895] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/05/2022] [Indexed: 01/17/2023] Open
Abstract
Deficits in health literacy are common in patients with coronary artery disease (CAD), and this is associated with increased morbidity and mortality. In this scoping review, we sought to identify health literacy interventions that aimed to improve outcomes in patients with CAD, using a contemporary conceptual model that captures multiple aspects of health literacy. We searched electronic databases for studies published since 2010. Eligible were studies of interventions supporting patients with CAD to find, understand and use health information via one of the following: building social support for health; empowering people with lower health literacy; improving interaction between patients and the health system; improving health literacy capacities of clinicians or facilitating access to health services. Studies were assessed for methodological quality, and findings were analysed through qualitative synthesis. In total, 21 studies were included. Of these, 10 studies aimed to build social support for health; 6 of these were effective, including those involving partners or peers. Five studies targeted interaction between patients and the health system; four of these reported improved outcomes, including through use of teach-back. One study addressed health literacy capacities of clinicians through communication training, and two facilitated access to health services via structured follow-up—all reporting positive outcomes. Health literacy is a prerequisite for CAD patients to self-manage their health. Through use of a conceptual framework to describe health literacy interventions, we identified mechanisms by which patients can be supported to improve health outcomes. Our findings warrant integration of these interventions into routine clinical practice.
Collapse
Affiliation(s)
- Alison Beauchamp
- Monash Rural Health, Monash University, Warragul, Victoria, Australia .,Department of Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jason Talevski
- Monash Rural Health, Monash University, Warragul, Victoria, Australia.,Department of Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Josef Niebauer
- University Institute of Sports Medicine, Institute of Molecular Sports and Rehabilitation Medicine, Paracelsus Medical University, Salzburg, Austria.,Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Johanna Gutenberg
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.,CAPHRI Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | | | - Barbara Mayr
- University Institute of Sports Medicine, Institute of Molecular Sports and Rehabilitation Medicine, Paracelsus Medical University, Salzburg, Austria.,Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Mahdi Sareban
- University Institute of Sports Medicine, Institute of Molecular Sports and Rehabilitation Medicine, Paracelsus Medical University, Salzburg, Austria.,Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Stefan Tino Kulnik
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.,Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| |
Collapse
|
13
|
Koch P, Schillmöller Z, Nienhaus A. How Does Health Literacy Modify Indicators of Health Behaviour and of Health? A Longitudinal Study with Trainees in North Germany. Healthcare (Basel) 2021; 10:2. [PMID: 35052166 PMCID: PMC8774634 DOI: 10.3390/healthcare10010002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/26/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Health literacy (HL) is a resource that can help individuals to achieve more control over their health and over factors that influence health. In the present follow-up study, we have investigated the extent to which HL in trainees changes over time and whether or to what extent HL influences health behaviour and health. METHODS In 2017, we performed a baseline survey (T0) of trainees from six different branches, who were contacted through vocational colleges in four northern federal states in Germany. The survey was repeated at the midpoint of their training in 2019 (T1). Demographic data were surveyed, together with information on HL (HLS-EU-Q16), health behaviour and on health status (psychological well-being, subjective health status). Multivariate regression analyses were performed in SPSS 26. RESULTS Three hundred and ninety-one (391) data sets were evaluated, with a follow-up rate of 27%; 79% of the trainees were female. The mean age was 21.2 years. Over all subjects, the mean HL increased over time (x¯ (SD): 11.9 (2.9) to 12.2 (2.9), p = 0.070). This increase was only statistically significant for the health service trainees (x¯ (SD): 12.1 (2.8) to 12.5 (2.9), p = 0.019). Relative to persons with adequate HL, the odds ratio over time for impaired psychological well-being was increased by 230% in persons with inadequate HL (OR: 3.3, 95% CI: 1.70-6.32, p < 0.001). For persons with problematical HL, the corresponding increase in odds ratio was 110% (OR: 2.1, 95% CI: 1.30-3.38, p = 0.002). Relative to persons with adequate HL, trainees with inadequate HL exhibited a significant increase in odds ratio of 2.8 over time for poor or less good subjective health status (OR: 2.8, 95% CI: 1.23-6.33, p = 0.014). CONCLUSIONS We observed a positive longitudinal association between HL and health. A significant increase in HL was observed in trainees in the health service. Thus the study shows that the concept of HL may provide a potential preventive approach for trainees.
Collapse
Affiliation(s)
- Peter Koch
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany;
| | - Zita Schillmöller
- Faculty of Life Sciences, Hamburg University of Applied Sciences (HAW), 21033 Hamburg, Germany;
| | - Albert Nienhaus
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany;
- Department for Occupational Medicine, Hazardous Substances and Health Sciences (AGG), German Social Accident Insurance for the Health and Welfare Services (BGW), 22089 Hamburg, Germany
| |
Collapse
|
14
|
Kostelanetz S, Pettapiece-Phillips M, Weems J, Spalding T, Roumie C, Wilkins CH, Kripalani S. Health Care Professionals' Perspectives on Universal Screening of Social Determinants of Health: A Mixed-Methods Study. Popul Health Manag 2021; 25:367-374. [PMID: 34698559 DOI: 10.1089/pop.2021.0176] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Social determinants of health (SDH) contribute to nearly 50% of health outcomes; however, SDH data collection is inconsistent in clinical practice. This study used mixed methods to evaluate health care professionals' perceptions of universal SDH screening at an academic medical center by surveying physicians, advanced practice providers, nurses, social workers, case managers, pharmacists, and administrators. An electronic survey assessed SDH screening practices, prioritization of SDH domains, disciplines to perform screening, and attitudes and barriers to universal screening. Likert-scale responses were dichotomized and compared disciplines with proportions tests. Qualitative interviews identified themes and elaborated survey findings. Participant discipline was the primary predictor variable. Of 193 survey participants (62.5% response rate), most were physicians (31%) or social workers (22%). Participants overwhelmingly reported using SDH information in patient care (93%), and social workers as the most appropriate role for screening (95%). Most respondents (75%) believed health literacy is important, but 40% reported routine assessment. Housing status (73% vs. 53%) and financial strain (62% vs. 48%) followed similar patterns. SDH screening barriers included lacking resources to address identified needs (51%), time to ask (45%), support staff to ask (33%), and training in responding to identified needs (28%). Social workers cited barriers less often than non-social workers (P < 0.001). Qualitative interviews (n = 16) supported survey findings and described barriers including lack of time, resources, standardized approaches, and professional burnout. Health care professionals support universal SDH screening while highlighting the need to address implementation barriers. Strategies should leverage social work expertise and optimize SDH data accessibility for all providers.
Collapse
Affiliation(s)
- Sophia Kostelanetz
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Jacy Weems
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tamarra Spalding
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christianne Roumie
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Consuelo H Wilkins
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
15
|
Sagi D, Spitzer-Shohat S, Schuster M, Daudi L, Rudolf MCJ. Teaching plain language to medical students: improving communication with disadvantaged patients. BMC MEDICAL EDUCATION 2021; 21:407. [PMID: 34320965 PMCID: PMC8320047 DOI: 10.1186/s12909-021-02842-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Low health literacy underpins health inequality and leads to poor adherence to medical care and higher risk of adverse events and rehospitalization. Communication in plain language, therefore, is an essential skill for health professionals to acquire. Most medical education communication skill programs focus on verbal communication, while written communication training is scarce. ETGAR is a student delivered service for vulnerable patients after hospital discharge in which, amongst other duties, students 'translate' the medical discharge letters into plain language and share them with patients at a home visit. This study ascertains how this plain language training impacted on students' written communication skills using a tool designed for purpose. METHODS Students, in pairs, wrote three plain language discharge letters over the course of a year for patients whom they encountered in hospital. The students handed over and shared the letters with the patients during a post-discharge home visit. Structured feedback from course instructors was given for each letter. An assessment tool was developed to evaluate students' ability to tell the hospitalization narrative using plain and clear language. First and last letters were blindly evaluated for the entire cohort (74 letters; 87 students). RESULTS Students scored higher in all assessment categories in the third letters, with significant improvement in overall score 3.5 ± 0.8 vs 4.1 ± 0.6 Z = -3.43, p = 0.001. The assessment tool's reliability was high α = 0.797, it successfully differentiated between plain language categories, and its score was not affected by letter length or patient's medical condition. CONCLUSIONS Plain language discharge letters written for real patients in the context of experience-based learning improved in quality, providing students with skills to work effectively in an environment where poor health literacy is prevalent. ETGAR may serve as a model for learning written communication skills during clinical years, using the assessment tool for formative or summative evaluation.
Collapse
Affiliation(s)
- Doron Sagi
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, 1311502, Safed, Israel.
- MSR- The Israel Center for Medical Simulation, Ramat-Gan, Israel.
| | - Sivan Spitzer-Shohat
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, 1311502, Safed, Israel
- Center for Health and the Social Sciences, University of Chicago, Chicago, USA
| | - Michal Schuster
- Faculty of Humanities, University of the Free State, Bloemfontein, South Africa
| | - Ligat Daudi
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, 1311502, Safed, Israel
| | - Mary Catharine Joy Rudolf
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, 1311502, Safed, Israel
| |
Collapse
|
16
|
Fan ZY, Yang Y, Zhang F. Association between health literacy and mortality: a systematic review and meta-analysis. Arch Public Health 2021; 79:119. [PMID: 34210353 PMCID: PMC8247180 DOI: 10.1186/s13690-021-00648-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/21/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To identify the relationship between health literacy (HL) and mortality based on a systematic review and meta-analysis. METHODS Literature published from database inception until July 2020 was searched using the PubMed and Web of Science databases, using relevant keywords and clear inclusion and exclusion criteria. The search was limited to English language articles. Two reviewers independently selected studies and extracted data. Pooled correlation coefficients and their 95% confidence intervals (CI) between HL and mortality were estimated using Stata 15.0 software. Potential sources of heterogeneity were explored using subgroup analysis, sensitivity analysis, and meta-regression. Quality of the original studies that were included in the meta-analysis was evaluated using the Newcastle-Ottawa Scale. A funnel plot and Egger's test were used to determine whether significant publication bias was present. RESULTS Overall, 19 articles were included, reporting on a total of 41,149 subjects. Eleven were prospective cohort studies, and all articles were considered "good" quality. The most used screening instruments were the short Test of Functional Health Literacy (S-TOFHLA) in Adults and the Brief Health Literacy Screen (BHLS). Among 39,423 subjects (two articles did not report the number of patients with low HL), approximately 9202 (23%) had inadequate or marginal HL. The correlation coefficient between HL and mortality was 1.25 (95%CI = 0.25-0.44). CONCLUSION Lower HL was associated with an increased risk of death. This finding should be considered carefully and confirmed by further research.
Collapse
Affiliation(s)
- Zhao-Ya Fan
- School of Public Health and Management, Chongqing Medical University, No.61 Daxuecheng Middle Road, Shapingba District, Chongqing, 400016, China
| | - Yuan Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fan Zhang
- School of Public Health and Management, Chongqing Medical University, No.61 Daxuecheng Middle Road, Shapingba District, Chongqing, 400016, China.
| |
Collapse
|
17
|
Steinke S, Koch P, Lietz J, Schillmöller Z, Nienhaus A. Health Literacy, Health Behavior and States of Health among Trainee Personnel in Northern Germany. Healthcare (Basel) 2021; 9:757. [PMID: 34207439 PMCID: PMC8235378 DOI: 10.3390/healthcare9060757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
(1) Background: The start of vocational education is a challenge for many people whose careers are just beginning. The working conditions exact new physical and mental tolls that can have an impact on their state of health and health behavior. Well-developed health literacy helps to encourage greater self-responsibility with respect to health and safety in the workplace. This study aimed to contribute to the evolution of health-related interventions in vocational training and instruction. (2) Methodology: This cross-sectional study examined health literacy, health behavior, and states of health among trainees engaged in work-and-study vocational training in 11 professions at the start of their education courses in northern Germany. The data were collected using a paper and pencil format. (3) Results: The survey was approved by 47 vocational schools (response rate 14%), with 1797 trainees returning their questionnaires (response rate 36%). The average age of the overall cohort was 21, and 70% of the trainees were female. A total of 47% of the participants began their careers with sufficient health literacy; health literacy was problematic in 40% of cases, and inadequate in 13% of cases. Around 50% of trainees exhibited poor dietary regime and risky alcohol intake, while 58% reported having a medical condition that had been previously formally diagnosed. (4) Conclusion: There is a need to provide support for developing a healthier approach to work at the start of vocational training.
Collapse
Affiliation(s)
- Susanne Steinke
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (S.S.); (J.L.); (A.N.)
| | - Peter Koch
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (S.S.); (J.L.); (A.N.)
| | - Janna Lietz
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (S.S.); (J.L.); (A.N.)
| | - Zita Schillmöller
- Faculty of Life Sciences, Hamburg University of Applied Sciences (HAW), 21033 Hamburg, Germany;
| | - Albert Nienhaus
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (S.S.); (J.L.); (A.N.)
- Department for Occupational Medicine, Hazardous Substances and Health Sciences (AGG), German Social Accident Insurance for the Health and Welfare Services (BGW), 22089 Hamburg, Germany
| |
Collapse
|
18
|
Kostelanetz S, Di Gravio C, Schildcrout JS, Roumie CL, Conway D, Kripalani S. Should We Implement Geographic or Patient-Reported Social Determinants of Health Measures In Cardiovascular Patients. Ethn Dis 2021; 31:9-22. [PMID: 33519151 DOI: 10.18865/ed.31.1.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives To compare patient-reported social determinants of health (SDOH) to the Brokamp Area Deprivation Index (ADI), and evaluate the association of patient-reported SDOH and ADI with mortality in patients with cardiovascular disease (CVD). Design Prospective cohort. Setting Academic medical center. Participants Adults with acute coronary syndrome (ACS) and/or acute exacerbation of heart failure (HF) hospitalized between 2011 and 2015. Methods Patient-reported SDOH included: income range, education, health insurance, and household size. ADI was calculated using census tract level variables of poverty, median income, high school completion, lack of health insurance, assisted income, and vacant housing. Primary Outcome All-cause mortality, up to 5 years follow-up. Results The sample was 60% male, 84% White, and 93% insured; mean patient-reported household income was $48,000 (SD $34,000). ADI components were significantly associated with corresponding patient-reported variables. In age, sex, and race adjusted Cox regression models, ADI was associated with mortality for ACS (HR 1.23, 95% CI 1.06, 1.42), but not HF (HR 1.09, 95% CI .99, 1.21). Mortality models for ACS improved with consideration of social determinants data (C-statistics: base demographic model=.612; ADI added=.644; patient-reported SDOH added=.675; both ADI and patient-reported SDOH added=.689). HF mortality models improved only slightly (C-statistics: .600, .602, .617, .620, respectively). Conclusions The Brokamp ADI is associated with mortality in hospitalized patients with CVD. In the absence of available patient-reported data, hospitals could implement the Brokamp ADI as an approximation for patient-reported data to enhance risk stratification of patients with CVD.
Collapse
Affiliation(s)
- Sophia Kostelanetz
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Chiara Di Gravio
- Department of Biostatistics, Vanderbilt University, Nashville, TN
| | | | - Christianne L Roumie
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Douglas Conway
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Sunil Kripalani
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
19
|
Friis K, Aaby A, Lasgaard M, Pedersen MH, Osborne RH, Maindal HT. Low Health Literacy and Mortality in Individuals with Cardiovascular Disease, Chronic Obstructive Pulmonary Disease, Diabetes, and Mental Illness: A 6-Year Population-Based Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249399. [PMID: 33333909 PMCID: PMC7765354 DOI: 10.3390/ijerph17249399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of the study was to examine the impact of health literacy on mortality in the general population and among individuals with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, and mental illness. METHODS Data from a large Danish health survey (n = 29,473) from 2013 were linked with national mortality registry data to permit a 6-year follow-up. RESULTS Individuals reporting difficulties in understanding information about health, had higher risk of dying during follow-up (hazard rate (HR) 1.38 (95% CI 1.11-1.73)) compared with those without difficulties. Higher risk was also observed among people reporting CVD (HR 1.47 (95% CI 1.01-2.14)), diabetes (HR 1.91 (95% CI 1.13-3.22)) and mental illness (HR 2.18 (95% CI 1.25-3.81)), but not for individuals with COPD. Difficulties in actively engaging with healthcare providers was not associated with an increase in the risk of dying in the general population or in any of the four long-term condition groups. CONCLUSIONS Aspects of health literacy predict a higher risk of dying during a 6-year follow-up period. Our study serves as a reminder to healthcare organizations to consider the health literacy responsiveness of their services in relation to diverse health literacy challenges and needs.
Collapse
Affiliation(s)
- Karina Friis
- DEFACTUM, Central Denmark Region, 8200 Aarhus, Denmark; (M.L.); (M.H.P.)
- Correspondence: ; Tel.: +45-78414335
| | - Anna Aaby
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, 8000 Aarhus, Denmark; (A.A.); (H.T.M.)
| | - Mathias Lasgaard
- DEFACTUM, Central Denmark Region, 8200 Aarhus, Denmark; (M.L.); (M.H.P.)
| | | | - Richard H. Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne 3025, Australia;
| | - Helle Terkildsen Maindal
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, 8000 Aarhus, Denmark; (A.A.); (H.T.M.)
- Health Promotion, Steno Diabetes Centre Copenhagen, 2820 Gentofte, Denmark
| |
Collapse
|
20
|
Mamudu HM, Wang L, Poole AM, Blair CJ, Littleton MA, Gregory R, Frierson L, Voigt C, Paul TK. Cardiovascular Diseases Health Literacy among Patients, Health Professionals, and Community-Based Stakeholders in a Predominantly Medically Underserved Rural Environment. South Med J 2020; 113:508-513. [PMID: 33005968 DOI: 10.14423/smj.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The central Appalachian region of the United States is disproportionately burdened with cardiovascular disease (CVD); however, the level of literacy about CVD among residents has not been well studied. This study aimed to examine the prevalence and factors of CVD health literacy (HL) among a sample of patients/caregivers, providers/professionals, and community stakeholders. METHODS In 2018, data were collected from central Appalachian residents in six states: Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia. CVD HL status was determined by assessing correct responses to five interrelated questions about basic knowledge of CVD. Multiple logistic regression analyses were used to examine the associations between potential factors and CVD HL status. RESULTS Of the total respondents (N = 82), <50% correctly answered all 5 CVD HL questions. Multiple logistic regression analyses showed that compared with respondents with advanced college degrees, those with a college degree or less were more likely to have low HL for "typical symptom of CVD," "physical exercise and CVD," "blood pressure and CVD," and "stress and CVD." In addition, compared with respondents younger than 50 years, those 50 years and older were 3.79 times more likely to have low HL for "physical exercise and CVD." CONCLUSIONS These results suggest the incorporation of CVD HL into CVD care and that educational attainments should be part of CVD policies and programs in the region.
Collapse
Affiliation(s)
- Hadii M Mamudu
- From the College of Public Health, East Tennessee State University, Johnson City, Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, Karing Hearts Cardiology Services, Johnson City, Mended Hearts, Johnson City Chapter, Johnson City, and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City
| | - Liang Wang
- From the College of Public Health, East Tennessee State University, Johnson City, Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, Karing Hearts Cardiology Services, Johnson City, Mended Hearts, Johnson City Chapter, Johnson City, and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City
| | - Amy M Poole
- From the College of Public Health, East Tennessee State University, Johnson City, Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, Karing Hearts Cardiology Services, Johnson City, Mended Hearts, Johnson City Chapter, Johnson City, and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City
| | - Cynthia J Blair
- From the College of Public Health, East Tennessee State University, Johnson City, Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, Karing Hearts Cardiology Services, Johnson City, Mended Hearts, Johnson City Chapter, Johnson City, and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City
| | - Mary Ann Littleton
- From the College of Public Health, East Tennessee State University, Johnson City, Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, Karing Hearts Cardiology Services, Johnson City, Mended Hearts, Johnson City Chapter, Johnson City, and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City
| | - Rob Gregory
- From the College of Public Health, East Tennessee State University, Johnson City, Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, Karing Hearts Cardiology Services, Johnson City, Mended Hearts, Johnson City Chapter, Johnson City, and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City
| | - Lynn Frierson
- From the College of Public Health, East Tennessee State University, Johnson City, Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, Karing Hearts Cardiology Services, Johnson City, Mended Hearts, Johnson City Chapter, Johnson City, and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City
| | - Carl Voigt
- From the College of Public Health, East Tennessee State University, Johnson City, Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, Karing Hearts Cardiology Services, Johnson City, Mended Hearts, Johnson City Chapter, Johnson City, and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City
| | - Timir K Paul
- From the College of Public Health, East Tennessee State University, Johnson City, Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, Karing Hearts Cardiology Services, Johnson City, Mended Hearts, Johnson City Chapter, Johnson City, and the James H. Quillen College of Medicine, East Tennessee State University, Johnson City
| |
Collapse
|
21
|
Health literacy among participants from neighbourhoods with different socio-economic statuses in the southern region of Hungary: a pilot study. BMC Public Health 2020; 20:1060. [PMID: 32799828 PMCID: PMC7429903 DOI: 10.1186/s12889-020-08959-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/24/2023] Open
Abstract
Background Health literacy (HL) has a deep impact on people’s decisions about their health and health care system. Measurement and improvement of HL level is essential to develop an appropriate health care system. The aim of the study was to (1) conduct a pilot study among the population of Baranya County in Hungary with different socio-economic statuses, (2) evaluate the HL level and (3) found the correlations between socio-economic data, emergency departments’ visits, medical history and HL. Methods In a cross-sectional study conducted in 2019 with 186 participants, socio-economic status, health status, HL level and knowledge about the triage system were measured. The questionnaire included questions on socio-economic status, previous chronic diseases, and satisfaction with the emergency care system as well as the standardised European Health Literacy Survey Questionnaire (HLS-EU-Q47). Descriptive statistical analysis (mean, SD, mode) and mathematical statistical analysis (ANOVA, chi2 test, Pearson Correlations, Two sample t-test) were applied. SPSS 24.0 statistical software was used to analyse the data. Relationships were considered significant at the p < 0.05 level. Results One hundred and eighty-six people were involved in the research, but 45 of them were excluded (N = 141). The participation rate was 75.8%. There were significant differences in HL levels by gender and educational level (p = 0.017), health education (p = 0.032) and presence of children in the household (p = 0.049). Educational level (p = 0.002) and type of settlement (p = 0.01) had strong impacts on economic status. We found that 46.1% of the participants had limited comprehensive HL (cHL) level. This proportion was slightly lower for the disease prevention sub-index (33.3%). The average cHL index score was 34.8 ± 8.7 points, the average health care sub-index score was 34.6 ± 9.7 points, the average disease prevention sub-index score was 35.8 ± 9.9 points, and the average health promotion sub-index score was 34.2 ± 9.4 points. 46.1% of the examined population in Hungary had limited HL level. Conclusions Socio-economic status has a strong influence on HL level. It is not enough to improve awareness but we need to improve knowledge and cooperation with the doctors and health care system.
Collapse
|
22
|
Abstract
PURPOSE Cardiac rehabilitation (CR) is effective at reducing further cardiac events. However, dropout rates are high, and maintenance of behavioral change post-CR is challenging. Health literacy (HL) may influence self-management of cardiac risk, yet few studies have explored this association. This study aimed to describe HL among CR attendees; first to describe the HL profiles of people commencing CR and second to examine HL changes between program entry and completion. METHODS CR attendees in Melbourne, Australia, completed the Health Literacy Questionnaire (HLQ) at program admission and completion. The HLQ measures HL across 9 scales. Cluster analysis grouped participants according to their HL profile. Effect sizes were used to determine changes in HLQ scores. Post-program interviews explored the role of HL in participant recovery. RESULTS Participants completed baseline (n = 60) and post-program (n = 38) data collection. Mean age was 60.3 ± 11.7 yr, and 38.3% had myocardial infarction and/or percutaneous coronary intervention. Approximately 18% of participants did not complete the program. Five HL clusters were revealed. The clusters most likely to drop out were confident users of the health system. The cluster least likely to drop out reported lower confidence in their ability to find health information and navigate services. Information-seeking ability improved over time, but no other HL improvements were seen. CONCLUSION There is a wide range of HL profiles in people attending CR. Findings suggest that CR programs should consider a variety of approaches to meet the diverse HL requirements of attendees.
Collapse
|
23
|
Roles for Physical Therapists to Address Health Literacy as a Social Determinant of Cardiovascular Disease: A Clinical Perspective. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Su K, Kato T, Toyofuku M, Morimoto T, Yaku H, Inuzuka Y, Tamaki Y, Ozasa N, Yamamoto E, Yoshikawa Y, Motohashi Y, Watanabe H, Kitai T, Taniguchi R, Iguchi M, Kato M, Nagao K, Kawai T, Komasa A, Nishikawa R, Kawase Y, Morinaga T, Jinnai T, Kawato M, Sato Y, Kuwahara K, Tamura T, Kimura T. Association of Previous Hospitalization for Heart Failure With Increased Mortality in Patients Hospitalized for Acute Decompensated Heart Failure. Circ Rep 2019; 1:517-524. [PMID: 33693094 PMCID: PMC7897572 DOI: 10.1253/circrep.cr-19-0054] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: We sought to explore the effects of previous heart failure (HF) hospitalization on mortality in patients hospitalized for acute decompensated HF (ADHF) in a large Japanese contemporary observational database. Methods and Results: We prospectively enrolled consecutive patients with ADHF in 19 participating hospitals between October 2014 and March 2016. Of 4,056 patients, 1,442 patients (35.4%) had at least 1 previous HF hospitalization (previous hospitalization group), while 2,614 patients (64.5%) did not have a history of HF hospitalization (de novo hospitalization group). Patients with previous hospitalization were older and more often had comorbidities such as anemia, and renal failure than those without. The cumulative 1-year incidence of all-cause death was significantly higher in the previous hospitalization group than in the de novo hospitalization group (28% vs. 19%, P<0.001). After adjusting confounders, the excess risk of the previous hospitalization group relative to the de novo hospitalization group for all-cause death remained significant (HR, 1.28; 95% CI: 1.10-1.50, P=0.001). The excess risk was significant in patients without advanced age, anemia, or renal failure, but not significant in patients with these comorbidities, with significant interaction. Increase in the number of hospitalizations was associated with an increased risk for mortality. Conclusions: In a contemporary ADHF cohort in Japan, repeated hospitalization was associated with an increasing, higher risk for 1-year mortality.
Collapse
Affiliation(s)
- Kanae Su
- Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
| | | | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine Nishinomiya Japan
| | - Hidenori Yaku
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
| | | | | | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
| | | | | | - Takeshi Kitai
- Kobe City Medical Center General Hospital Kobe Japan
| | - Ryoji Taniguchi
- Hyogo Prefectural Amagasaki General Medical Center Amagasaki Japan
| | - Moritake Iguchi
- National Hospital Organization Kyoto Medical Center Kyoto Japan
| | | | | | | | | | | | | | | | | | | | - Yukihito Sato
- Hyogo Prefectural Amagasaki General Medical Center Amagasaki Japan
| | | | - Takashi Tamura
- Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
| | | |
Collapse
|
25
|
Greaves RF, Bernardini S, Ferrari M, Fortina P, Gouget B, Gruson D, Lang T, Loh TP, Morris HA, Park JY, Roessler M, Yin P, Kricka LJ. Key questions about the future of laboratory medicine in the next decade of the 21st century: A report from the IFCC-Emerging Technologies Division. Clin Chim Acta 2019; 495:570-589. [DOI: 10.1016/j.cca.2019.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/21/2022]
|
26
|
Ventura HO, Piña IL. The Impact of Mediators of Health Literacy on Clinical Outcomes in Cardiovascular Diseases. Mayo Clin Proc 2018; 93:1700-1702. [PMID: 30522589 DOI: 10.1016/j.mayocp.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 11/23/2022]
Affiliation(s)
- Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA.
| | - Ileana L Piña
- Albert Einstein College of Medicine and Montefiore Heart and Vascular Center, Bronx, NY
| |
Collapse
|