A study from Columbia University School of Nursing in New York published in an August issue of the Journal of Cardiovascular Nursing found that 40% of patients with pacemakers and defibrillators had little to no understanding of information about their cardiac health.
As a nurse practitioner, I use every patient encounter as an opportunity for education, lead author Kathleen Hickey, EdD, ANP-BC, FNP-BC, assistant professor at Columbia Nursing, said in a news release. Health literacy is a particular concern for patients with pacemakers and defibrillators because these patients need to know how to respond if they get a shock from their device. Even when the device is quiet, they often need to know how to manage co-existing health conditions like diabetes, heart failure and high blood pressure.
Risks can stem from some common misunderstandings between patients and clinicians, Hickey said. A patient might ignore advice to avoid rigorous exercise and then be surprised when experiencing an irregular heartbeat, for example. Or, patients instructed to check their pulse regularly and report any abnormal activity might not understand how to do this or what heart rate is cause for alarm.
Its not enough just to explain the same thing again in the same way, she said in the release. You have to stop to ask more specific questions like what activities they do in a typical day and offer simple instructions so they understand, for example, the appropriate heart rate zone for exercise.
To understand the scope of potential communication problems at the clinic where she practices in New York City, Hickey and a team of researchers evaluated the health literacy of 116 patients using a standard measure of reading and math comprehension, the Test of Functional Health Literacy in Adults. The study population was 37.1% white, 39.7% Hispanic and 22.4% African-American. Of that population, 77.4% reported finishing high school. The average age of the study population was 68. Evaluations were done in English or Spanish. Almost 30% of participants had inadequate health literacy, and another 10% were marginal, the study found. According to the CDC, limited health literacy is associated with poorer health outcomes, higher rates of hospitalizations, increased use of the ED, improper use of medications and higher healthcare costs.
The study, Assessing Health Literacy in Urban Patients with Implantable Cardioverter Defibrillators and Pacemakers, also examined literacy among patients with medical conditions common among those with pacemakers and defibrillators. Individuals with hypertension or high cholesterol were more than twice as likely to have limited health literacy as people without those conditions. Patients with diabetes were almost twice as likely to have low health literacy, the findings showed.