Martins Maria Auxiliadora Parreiras, Costa Josiane Moreira, Mambrini Juliana Vaz de Melo, Ribeiro Antonio Luiz Pinho, Benjamin Emelia J, Brant Luisa Campos Caldeira, Paasche-Orlow Michael K, Magnani Jared W
Hospital das Clínicas and Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Heart. 2017 Jul;103(14):1089-1095. doi: 10.1136/heartjnl-2016-310699. Epub 2017 Mar 3.
Health literacy has been related to health-related conditions and health outcomes. Studies examining the association of health literacy and anticoagulation have had variable results. We sought to investigate the relations of health literacy and percentage of time in therapeutic range (TTR) in a vulnerable Brazilian cohort at two hospital-based anticoagulation clinics.
We measured health literacy with the Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18) in 2015-2016. We identified the demographic and clinical characteristics associated with health literacy and related health literacy to TTR.
We enrolled 422 adults prescribed chronic warfarin therapy in our observational study (median age 62.1 years; 58.8% women; monthly income $200.00). The prevalence of inadequate health literacy (score 0-14 points) was 72.3% with a median score of 12 (quartiles, Q1=10; Q3=15) on the SAHLPA-18. The median TTR was 66.1%. In the multivariable logistic analysis, cognitive impairment and assistance with taking warfarin were associated with inadequate health literacy. Prosthetic heart valves and more school years were associated with adequate health literacy. Our analyses showed no significant relation between health literacy and TTR, analysing health literacy as a categorical (adjusted OR 1.05; 95% CI 0.65 to 1.70) or continuous variable (Spearman's coefficient 0.02; p=0.70).
Inadequate health literacy was highly prevalent in this impoverished Brazilian cohort receiving anticoagulation with warfarin. However, we did not identify an association between health literacy and TTR. Future investigations may consider the systemic factors that contribute towards successful anticoagulation outcomes for vulnerable patient cohorts with inadequate health literacy.
健康素养与健康相关状况及健康结果有关。研究健康素养与抗凝之间关联的结果各不相同。我们试图在巴西两家医院的抗凝门诊中，调查一个脆弱队列中健康素养与治疗范围内时间百分比（TTR）之间的关系。
我们在2015 - 2016年用葡萄牙语成人健康素养简短评估（SAHLPA - 18）测量健康素养。我们确定了与健康素养相关的人口统计学和临床特征，并将健康素养与TTR相关联。
我们的观察性研究纳入了422名接受慢性华法林治疗的成年人（中位年龄62.1岁；58.8%为女性；月收入200.00美元）。在SAHLPA - 18上，健康素养不足（得分0 - 14分）的患病率为72.3%，中位得分为12分（四分位数，Q1 = 10；Q3 = 15）。TTR的中位数为66.1%。在多变量逻辑分析中，认知障碍和服用华法林时得到帮助与健康素养不足相关。人工心脏瓣膜和受教育年限较长与健康素养充足相关。我们的分析表明，将健康素养作为分类变量（调整后的OR为1.05；95%CI为0.65至1.70）或连续变量分析时，健康素养与TTR之间无显著关系（Spearman系数为0.02；p = 0.70）。
在这个接受华法林抗凝治疗的贫困巴西队列中，健康素养不足非常普遍。然而，我们未发现健康素养与TTR之间存在关联。未来的研究可能会考虑那些有助于健康素养不足的脆弱患者队列实现成功抗凝结果的系统因素。
