Factors associated with exacerbation of heart failure include treatment adherence and health literacy skills

Clin Pharmacol Ther. 2009 Jun;85(6):651-8. doi: 10.1038/clpt.2009.7. Epub 2009 Mar 4.


We determined the factors associated with exacerbation of heart failure, using a cohort (n = 192) nested within a randomized trial at a university-affiliated ambulatory practice. Factors associated with emergency or hospital care included left ventricular ejection fraction, hematocrit and serum sodium levels, refill adherence, and the ability to read a prescription label. Refill adherence of <40% was associated with a threefold higher incidence of hospitalization for heart failure than a refill adherence of >or=80% (P = 0.002). In multivariable analysis, prescription label reading skills were associated with a lower incidence of heart failure-specific emergency care (incidence rate ratio, 0.76; 95% confidence interval (CI), 0.19-0.69), and participants with adequate health literacy had a lower risk of hospitalization for heart failure (incidence rate ratio, 0.34; 95% CI, 0.15-0.76). We conclude that inadequate treatment adherence and health literacy skills are key factors in the exacerbation of heart failure. These findings emphasize the need for careful instruction of patients about their medications.

Trial registration: ClinicalTrials.gov NCT00388622.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Cohort Studies
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Heart Failure / drug therapy*
  • Hematocrit
  • Hospitalization / statistics & numerical data
  • Humans
  • Insurance Claim Review / statistics & numerical data
  • Male
  • Medical Assistance
  • Medication Adherence*
  • Middle Aged
  • Patient Education as Topic*
  • Sodium / blood
  • Stroke Volume


  • Sodium

Associated data

  • ClinicalTrials.gov/NCT00388622