Better Health Literacy May Improve QOL of Hospitalized Patients With Heart Failure

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Due to a lack of comprehensive data on health literacy among these patients, a team of investigators looked at its connection with their quality of life (QOL).

Due to a lack of comprehensive data on health literacy among patients with heart failure (HF), a team of investigators from National Institute of Cardiology (NIC), in Brazil, looked at how it affects their quality of life (QOL) when in the hospital. The results of their cross-sectional exploratory study appeared in a recent issue of American Journal of Cardiovascular Disease.

The mean (SD) patient age was 51.0 (12.8) years, most (62%) were male, a majority (58%) had New York Heart Association (NYHA) functional class III disease, and the most common (56% each) comorbidities were hypertension and dyslipidemia.

“HF patients’ clinical stability is more than the pharmacological prescription; it includes improvement in adherence to treatment and in self-care behaviors, which can be enhanced through the multidisciplinary team follow-up and by stimulation of health literacy,” the authors noted. “The objective of the present study is to evaluate the association between health literacy and QoL in hospitalized HF patients.”

Outcomes were assessed among 50 patients whose left ventricular ejection fraction (LVEF) was less than 45% on the last available echocardiogram and who had been admitted to NIC at least 24 hours before. The Questionnaire about Heart Failure Patients’ Knowledge of Disease and Minnesota Living with Heart Failure Questionnaire were administered to gauge health literacy and QOL, respectively. Clinical data (LVEF, NYHA functional class, HF etiology, comorbidities, and hemodynamic profile) were gleaned from patients’ medical records.

Three educational methods were provided:

  • Educational leaflet
  • Educational group
  • Leaflet plus educational group or none

The mean (SD) scores were 34.2 (15.1) for health literacy and 73.5 (19.8) for QOL. The most common educational method, at 48%, was leaflet plus educational group, and most patients were assessed as having either good (34%) or acceptable (26%) knowledge levels about their HF.

Independent associations were seen between QOL and the following outcomes:

  • Hospitalization rate in the past year (β = 3.9; 95% CI, 1.0-6.7; P = .009)
  • Total health literacy score (β = –0.4; 95% CI, –0.7 to –0.1; P = .024)
  • Good knowledge category (β = –20.2; 95% CI, –36.5 to –4.0; P = .016)

Adjusting for age and sex produced similar results:

  • Hospitalization rate in the past year (β = 3.9; 95% CI, 1.1-6.7; P = .007)
  • Total health literacy score (β = –0.3; 95% CI, –0.7 to 0.1; P = .066)
  • Good knowledge category (β = –19.4; 95% CI, –36.9 to –1.9; P = .031)

NYHA functional class III (β = 15.3; 95% CI, 1.6-28.9; P = .029) was also significantly associated with QOL score.

“The main finding of the present study was that good levels of health literacy are associated with better levels of QOL in hospitalized HF patients,” the authors concluded. “the multidisciplinary team could be a key point to improve the patients’ knowledge about their disease, their adherence to treatment and consequently their QOL.”

Possible limitations to their findings are the small sample size and not being able to determine causality because of the cross-sectional nature of the study.


Lima MA, Duque AP, Rodrigues LF Jr, Lima VCS, Trotte LAC, Guimaraes TCF. Health literacy and quality of life in hospitalized heart failure patients: a cross-sectional study. Am J Cardiovasc Dis. 2020;10(4):490-498.