Reading Stephanie R, Go Alan S, Fang Margaret C, Singer Daniel E, Liu In-Lu Amy, Black Mary Helen, Udaltsova Natalia, Reynolds Kristi
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
J Am Heart Assoc. 2017 Apr 11;6(4):e005128. doi: 10.1161/JAHA.116.005128.
Atrial fibrillation (AF) is the most common clinically significant arrhythmia in adults and a major risk factor for ischemic stroke. Nonetheless, previous research suggests that many individuals diagnosed with AF lack awareness about their diagnosis and inadequate health literacy may be an important contributing factor to this finding.
We examined the association between health literacy and awareness of an AF diagnosis in a large, ethnically diverse cohort of Kaiser Permanente Northern and Southern California adults diagnosed with AF between January 1, 2006 and June 30, 2009. Using self-reported questionnaire data completed between May 1, 2010 and September 30, 2010, awareness of an AF diagnosis was evaluated using the question "Have you ever been told by a doctor or other health professional that you have a heart rhythm problem called atrial fibrillation or atrial flutter?" and health literacy was assessed using a validated 3-item instrument examining problems because of reading, understanding, and filling out medical forms. Of the 12 517 patients diagnosed with AF, 14.5% were not aware of their AF diagnosis and 20.4% had inadequate health literacy. Patients with inadequate health literacy were less likely to be aware of their AF diagnosis compared with patients with adequate health literacy (prevalence ratio=0.96; 95% CI [0.94, 0.98]), adjusting for sociodemographics, health behaviors, and clinical characteristics.
Lower health literacy is independently associated with less awareness of AF diagnosis. Strategies designed to increase patient awareness of AF and its complications are warranted among individuals with limited health literacy.
心房颤动（AF）是成人中最常见的具有临床意义的心律失常，也是缺血性中风的主要危险因素。尽管如此，先前的研究表明，许多被诊断为房颤的个体对自己的诊断缺乏认知，健康素养不足可能是导致这一现象的重要因素。
我们在2006年1月1日至2009年6月30日期间诊断为房颤的北加利福尼亚和南加利福尼亚凯撒医疗机构的一个大型、种族多样的成年人群队列中，研究了健康素养与房颤诊断认知之间的关联。使用2010年5月1日至2010年9月30日期间完成的自我报告问卷数据，通过“您是否曾被医生或其他健康专业人员告知您患有称为心房颤动或心房扑动的心律问题？”这一问题来评估对房颤诊断的认知，并使用经过验证的包含三个项目的工具来评估因阅读、理解和填写医疗表格而产生的问题，以此来评估健康素养。在12517名被诊断为房颤的患者中，14.5%不知道自己被诊断为房颤，20.4%的患者健康素养不足。与健康素养充足的患者相比，健康素养不足的患者知晓房颤诊断的可能性较小（患病率比值=0.96；95%可信区间[0.94, 0.98]），对社会人口统计学、健康行为和临床特征进行了调整。
较低的健康素养与对房颤诊断的认知不足独立相关。对于健康素养有限的个体，有必要采取旨在提高患者对房颤及其并发症认知的策略。
