Kollipara Usha K, Jaffer Osman, Amin Aamir, Toto Kathleen H, Nelson Lauren L, Schneider Ruth, Markham David, Drazner Mark H
Parkland Memorial Hospital, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Am J Cardiol. 2008 Nov 1;102(9):1212-5. doi: 10.1016/j.amjcard.2008.06.047. Epub 2008 Aug 27.
It has previously been demonstrated that patients with heart failure (HF) in an urban public hospital had significant gaps in knowledge regarding dietary sodium restriction. The objective of this study was to determine what risk factors were associated with such gaps in knowledge and to determine if these gaps in knowledge would increase the risk for HF readmission. A standardized test of sodium knowledge (scored 0 to 10) was administered prospectively to 97 hospitalized patients with HF <48 hours before discharge. The incidence of 90-day hospital readmission for HF was compared between subjects with low dietary sodium knowledge (score 0 to 3) and the remainder of the cohort (score 4 to 10) in univariate and multivariate analyses. Another 48 patients with HF were prospectively recruited, and the dietary sodium knowledge test and a survey of psychosocial and other parameters, including the Test of Functional Health Literacy in Adults, a validated measure of health literacy, were administered. The 90-day readmission rate for HF was 3 times higher in those with low sodium knowledge than in the remainder of the cohort (28% vs 9%, p = 0.02). This association persisted in multivariate models adjusting for potential confounders. Low health literacy, but not other psychosocial parameters, was associated with low dietary sodium knowledge. In conclusion, low dietary sodium knowledge was an independent risk factor for 90-day HF hospital readmission in the urban setting. Deficiency in dietary sodium knowledge is one pathway through which low health literacy leads to adverse outcomes in patients with HF.
此前已有研究表明，城市公立医院中的心衰（HF）患者在饮食钠限制方面存在显著的知识差距。本研究的目的是确定哪些风险因素与这些知识差距相关，并确定这些知识差距是否会增加心衰再入院的风险。在97例出院前<48小时的住院心衰患者中，前瞻性地进行了一项钠知识标准化测试（评分0至10分）。在单因素和多因素分析中，比较了低饮食钠知识组（评分0至3分）和队列其余组（评分4至10分）的心衰90天再入院发生率。另外前瞻性招募了48例心衰患者，并进行了饮食钠知识测试以及一项心理社会和其他参数的调查，包括成人功能性健康素养测试（一种经过验证的健康素养测量方法）。钠知识水平低的患者的心衰90天再入院率比队列其余患者高3倍（28%对9%，p = 0.02）。在调整潜在混杂因素的多因素模型中，这种关联仍然存在。低健康素养而非其他心理社会参数与低饮食钠知识相关。总之，在城市环境中，低饮食钠知识是心衰90天再入院的独立危险因素。饮食钠知识缺乏是低健康素养导致心衰患者不良结局的一条途径。
