Educational Level Linked To Increased Hospitalization In Heart Failure Patients

Patients with heart failure are at increased risk of hospitalization if they or their spouses have a high school education or less. The study, published this month on-line in the International Journal of Cardiology, is the first to look directly at the effect of low education levels in heart failure patients.

July 31, 2007

BIRMINGHAM, Ala. - Patients with heart failure are at increased risk of hospitalization if they or their spouses have a high school education or less. The study, published this month on-line in the International Journal of Cardiology, is the first to look directly at the effect of low education levels in heart failure patients.

“The findings from our study show that low patient and spousal education has negative consequences for heart failure patients,” said Ali Ahmed, M.D., MPH, associate professor in the division of gerontology, geriatrics and palliative care medicine and director of UAB’s Geriatric Heart Failure Clinic, and senior author of the study. “These findings are even more relevant for patients newly diagnosed with heart failure as therapy for heart failure has evolved to be more complicated over time.”

Ahmed’s group studied 571 patients enrolled in the quality of life sub-study of the Digitalis Investigation Group, a large clinic trial of heart failure patients conducted in 302 centers in the United States and Canada from 1991-1993. The study was funded by a grant from the National Heart, Lung and Blood Institute (NHLBI), one of the National Institutes of Health.

Ahmed and colleagues found that compared to patients with greater than 12 years of patient or spousal education, those with less education had more than a 50 percent increase in the risk of hospitalization due to all causes and cardiovascular causes. Lower education was also associated with an over 50 percent increased risk of mortality from all causes and cardiovascular causes; however, these associations were not statistically significant.

Ahmed said this was likely due to the small sample size of the study. He points out that hospitalization is often a marker of disease progression in heart failure and it is not surprising that conditions that increased the risk of hospitalization may also increase the risk of death.

“This study points to the compelling need for better health education,” said Ahmed. “Better education means better outcomes. We need targeted heart failure education for patients with low self or spousal education levels.”

Dr. Xuemei Sui from the University of South Carolina, Columbia, SC was the lead author on the study. Other co-researchers were Mihai Gheorghiade, M.D., from Northwestern University, Chicago, IL; Faiez Zannad, M.D, Ph.D., from University Henri Poincare´, Nancy, France; and James B. Young, M.D., from the Cleveland Clinic Foundation, Cleveland, OH.