General and disease-specific health literacy in patients with heart failure: an outcome analysis

INTRODUCTION: Limited health literacy is common among patients with heart failure (HF), and the relative importance of general and disease-specific health literacy for patient outcomes remains unclear. This study aimed to evaluate general and disease-specific health literacy in patients with HF and to examine their association with behavioural, patient-reported and clinical outcomes. METHODS: This prospective observational study included 126 outpatients with HF (mean age 69 ± 11 years; 71% male) who were followed for 6 months. General health literacy was assessed using the Brief Health Literacy Screen (BHLS), and disease-specific health literacy using the Heart Failure-Specific Health Literacy Scale (HFsHLS). RESULTS: The two measures were moderately positively correlated (Spearman's ρ = 0.49, P < .001), indicating partial overlap. Limited general health literacy (BHLS ≤ 9) was identified in 22% of patients and was associated with lower educational level, more depressive symptoms, higher NT-proBNP levels, and a greater number of prescribed medications (all P < .05). In univariable analyses, both health literacy measures were associated with better HF-related knowledge (P = .004 and .049), higher health-related quality of life (P < .001 and .007), and better self-rated health (P < .001 for both), which was not sustained after multivariable adjustment. Additionally, disease-specific health literacy was associated with self-care behaviours (P = .033), also after multivariable adjustment (P = .026). Neither measure was independently associated with clinical outcomes (death, HF hospitalization, emergency department visit); however, patients with limited general health literacy showed numerically higher event rates and a tendency towards increased risk of clinical outcomes. CONCLUSION: In patients with HF, limited general health literacy was observed in 22% of patients. General and disease-specific health literacy measures were not interchangeable, and only disease-specific health literacy showed an independent association with self-care behaviours. A tendency towards less favourable clinical outcomes was observed among patients with limited general health literacy.