DOI: 10.1161/circ.148.suppl_1.14050 ISSN: 0009-7322

Abstract 14050: Association of Health Literacy With Hospital Readmission and Mortality After Heart Transplantation

Debra D Dixon, Meng Xu, Brandon D Lowery, Kayla A Buttafuoco, Lauren Lee Shaffer, Quinn S Wells, Sunil Kripalani, Deepak K Gupta, Kelly H Schlendorf
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background: Higher health literacy is associated with lower risk of hospitalization and mortality in patients with heart failure (HF). Health literacy assessment is recommended in patients undergoing heart transplant evaluation, yet few data report health literacy status or its associations with post-heart transplant outcomes.

Objective: To characterize health literacy among heart transplant recipients and investigate its associations with post-transplant hospital readmissions and mortality.

Methods: We retrospectively analyzed 513 patients (median age 57 years, 28% female, 27% Black) who underwent heart transplantation at Vanderbilt University Medical Center between 2015-2021. Health literacy was assessed using the validated 3-item Brief Health Literacy Screen (BHLS). Each item is on a 5-point Likert scale yielding a total score range of 3-15, with 15 indicating optimal health literacy. All cause readmissions post-transplant were ascertained from the electronic medical record (EMR). Vital status was determined through linkage with the Social Security death index or the EMR through March 2023. Ordinal logistic and Cox models adjusted for age at transplant, sex, race, body mass index, hypertension, dialysis at time of transplant, length of stay post-transplant, and wait list status at transplant were used to quantify associations between health literacy and readmissions or mortality, respectively.

Results: The median BHLS score was 14 and 42% of patients had a score of 15. In the year following transplantation, 288 (56%) patients had 661 rehospitalizations. In the multivariable adjusted model, BHLS of 15 compared to any lower score associated with 29% lower odds of readmission (OR 0.71, 95% CI: 0.51, 0.99). Over a median 2.8 years (IQR 1.7, 4.9) follow-up, 90 individuals died. Health literacy was not associated with mortality (HR 1.10, 95% CI: 0.69, 1.73).

Conclusions: At a high-volume heart transplant center, optimal health literacy was present in the minority of patients and associated with lower risk of post-transplant hospital readmissions, but neutral association with mortality. Screening for health literacy and providing transplant education that is clear and accessible at all literacy levels may improve post-transplant outcomes.

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