Relation of Lack of Knowledge About Dietary Sodium to Hospital Readmission in Patients With Heart Failure

      It has previously been demonstrated that patients with heart failure (HF) in an urban public hospital had significant gaps in knowledge regarding dietary sodium restriction. The objective of this study was to determine what risk factors were associated with such gaps in knowledge and to determine if these gaps in knowledge would increase the risk for HF readmission. A standardized test of sodium knowledge (scored 0 to 10) was administered prospectively to 97 hospitalized patients with HF <48 hours before discharge. The incidence of 90-day hospital readmission for HF was compared between subjects with low dietary sodium knowledge (score 0 to 3) and the remainder of the cohort (score 4 to 10) in univariate and multivariate analyses. Another 48 patients with HF were prospectively recruited, and the dietary sodium knowledge test and a survey of psychosocial and other parameters, including the Test of Functional Health Literacy in Adults, a validated measure of health literacy, were administered. The 90-day readmission rate for HF was 3 times higher in those with low sodium knowledge than in the remainder of the cohort (28% vs 9%, p = 0.02). This association persisted in multivariate models adjusting for potential confounders. Low health literacy, but not other psychosocial parameters, was associated with low dietary sodium knowledge. In conclusion, low dietary sodium knowledge was an independent risk factor for 90-day HF hospital readmission in the urban setting. Deficiency in dietary sodium knowledge is one pathway through which low health literacy leads to adverse outcomes in patients with HF.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Neily J.B.
        • Toto K.H.
        • Gardner E.B.
        • Rame J.E.
        • Yancy C.W.
        • Sheffield M.A.
        • Dries D.L.
        • Drazner M.H.
        Potential contributing factors to noncompliance with dietary sodium restriction in patients with heart failure.
        Am Heart J. 2002; 143: 29-33
        • Kollipara U.K.
        • Mo V.
        • Toto K.H.
        • Nelson L.L.
        • Schneider R.A.
        • Neily J.B.
        • Drazner M.H.
        High-sodium food choices by southern, urban African Americans with heart failure.
        J Card Fail. 2006; 12: 144-148
        • Mehta S.K.
        • Toto K.H.
        • Nelson L.L.
        • Drazner M.H.
        Therapy of heart failure in African Americans: lessons from an urban public hospital.
        Congest Heart Fail. 2004; 10: 40-43
        • Parker R.M.
        • Baker D.W.
        • Williams M.V.
        • Nurss J.R.
        The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills.
        J Gen Intern Med. 1995; 10: 537-541
      1. Research Triangle Institute. 2006 National Survey on Drug Use and Health, 2005. Available at: Accessed August 8, 2008.

        • Victor R.G.
        • Haley R.W.
        • Willett D.L.
        • Peshock R.M.
        • Vaeth P.C.
        • Leonard D.
        • Basit M.
        • Cooper R.S.
        • Iannacchione V.G.
        • Visscher W.A.
        • et al.
        The Dallas Heart Study: a population-based probability sample for the multidisciplinary study of ethnic differences in cardiovascular health.
        Am J Cardiol. 2004; 93: 1473-1480
        • Estep J.D.
        • Mehta S.K.
        • Uddin F.
        • King L.
        • Toto K.H.
        • Nelson L.L.
        • Dries D.L.
        • Yancy C.W.
        • Drazner M.H.
        Beta-blocker therapy in patients with heart failure in the urban setting: moving beyond clinical trials.
        Am Heart J. 2004; 148: 958-963
        • Bentley B.
        • de Jong M.
        • Moser D.K.
        • Peden A.
        Factors related to nonadherence to low sodium diet recommendations in heart failure patients.
        Eur J Cardiovasc Nursing. 2005; 4: 331-336
        • Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs
        • American Medical Association
        Health literacy: report of the Council on Scientific Affairs.
        JAMA. 1999; 281: 552-557
        • Kutner M.
        • Greenberg E.
        • Jin Y.
        • Paulsen C.
        The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483).
        United States Department of Education, Washington, District of Columbia2006
        • Paasche-Orlow M.K.
        • Parker R.M.
        • Gazmararian J.A.
        • Nielsen-Bohlman L.T.
        • Rudd R.R.
        The prevalence of limited health literacy.
        J Gen Intern Med. 2005; 20: 175-184
        • Baker D.W.
        • Gazmararian J.A.
        • Williams M.V.
        • Scott T.
        • Parker R.M.
        • Green D.
        • Ren J.
        • Peel J.
        Functional health literacy and the risk of hospital admission among Medicare managed care enrollees.
        Am J Public Health. 2002; 92: 1278-1283
        • Baker D.W.
        • Wolf M.S.
        • Feinglass J.
        • Thompson J.A.
        • Gazmararian J.A.
        • Huang J.
        Health literacy and mortality among elderly persons.
        Arch Intern Med. 2007; 167: 1503-1509
        • Schillinger D.
        • Grumbach K.
        • Piette J.
        • Wang F.
        • Osmond D.
        • Daher C.
        • Palacios J.
        • Sullivan G.D.
        • Bindman A.B.
        Association of health literacy with diabetes outcomes.
        JAMA. 2002; 288: 475-482