02:18am Saturday 04 July 2020

Health Literacy Impacts Chance of Heart Failure Hospitalization, Study Says

News Article ImageFindings were presented Nov. 17 at the American Heart Association Scientific Sessions conference in Chicago.

Javed Butler, MD, MPH, professor of medicine, Emory School of Medicine and director of Heart Failure Research at Emory Healthcare.

The research, led by Emory cardiologist Javed Butler, MD, MPH, professor of medicine, Emory School of Medicine and director of Heart Failure Research at Emory Healthcare, involved the use of a simple test called the Rapid Estimates of Adults Literacy in Medicine (REALM-R).

“This study lends more insight about the importance of health literacy and the impact it has on a patient’s participation in their care,” says Butler, who also serves as the deputy chief science advisor for the American Heart Association. “We learned that below optimal health literacy is driven by low socioeconomic status and is associated with increased admission rates in patients with heart failure.”

REALM-R is a word recognition test designed to assist medical professionals in identifying patients at risk for poor literacy skills and playing a role in predicting their ability to control a chronic condition like heart failure. Adults are asked to de-code or pronounce a short list of words. The test takes less than two minutes to administer and score. Emory researchers administered the REALM-R test to 154 heart failure outpatients from January 2008 to July 2009. People with a score of 60 or lower (considered low or marginal) had a 55 percent higher rate of hospitalization for any reason.

Among the 154 patients, 30 had a low REALM-R score. People with annual family income less than $50,000, African-Americans, and people without a college-level education were much more likely to have a low REALM-R score (ten-fold, five-fold and five-fold, respectively). Gender was not linked to REALM-R score.

What doctors call “hard events” (death, urgent cardiac transplantation, or ventricular assist device implantation) did not increase based on low REALM-R score.

The interdisciplinary study was co-authored by Emory University cardiovascular nursing researcher Sandra Dunbar, RN, DSN, FAAN, FAHA and Vasiliki Georgiopoulou, MD, assistant professor of medicine, Emory School of Medicine who also presented the study at the meeting.

More information about the REALM-R test is available online.


The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service. Its components include the Emory University School of Medicine, Nell Hodgson Woodruff School of Nursing, and Rollins School of Public Health; Yerkes National Primate Research Center; Winship Cancer Institute of Emory University; and Emory Healthcare, the largest, most comprehensive health system in Georgia. Emory Healthcare includes: The Emory Clinic, Emory-Children’s Center, Emory University Hospital, Emory University Hospital Midtown, Wesley Woods Center, and Emory University Orthopaedics & Spine Hospital.  The Woodruff Health Sciences Center has a $2.5 billion budget, 17,600 employees, 2,500 full-time and 1,500 affiliated faculty, 4,700 students and trainees, and a $5.7 billion economic impact on metro Atlanta.

  1. Jennifer Johnson: 404-727-5696

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