CONGRESS ABSTRACT

Background: Health literacy (HL) is a risk factor for clinical outcomes in patients with cardiovascular diseases. This study explored HL levels and their impact, alongside clinical and nursing factors, on mortality, hospital readmissions, and emergency department (ED) visits in patients with atrial fibrillation. Methods: A prospective cohort study was conducted at an Italian university hospital among adults with atrial fibrillation as the primary medical diagnosis between December 2020 and June 2021. Data collection included HL levels and sociodemographic, clinical, and nursing-related variables (e.g., nursing diagnoses identified within the first 24 hours of hospitalization and the number of nursing interventions delivered during the hospital stay). Patients were followed for 12 months to assess the study outcomes. Cox proportional hazard models analyzed associations between HL, nursing and clinical complexities, and outcomes. Results: Among 441 patients (mean age 73.6 ± 11.9 years), over 70% had inadequate HL. During follow-up, 138 patients were lost, while 57 (17.8%) died, 117 (38.6%) were readmitted, and 99 (35.9%) had ED visits. The number of nursing diagnoses predicted mortality in univariable (HR 1.23; 95% CI: 1.14–1.32; p<0.001) and multivariable analysis (HR 1.18; 95% CI: 1.06–1.32; p<0.005). The HL level independently predicted mortality (HR 1.40; 95% CI: 1.01–1.96; p<0.05). For readmissions, predictors included age (HR 1.05; 95% CI: 1.03–1.07; p<0.001), length of stay (HR 0.92; 95% CI: 0.87–0.97; p<0.005), number of nursing diagnoses (HR 1.30; 95% CI: 1.15–1.46; p<0.001), and HL levels (HR 1.46; 95% CI: 1.15–1.86; p<0.005). For ED visits, predictors included age (HR 1.04; 95% CI: 1.02–1.07; p<0.001), number of nursing diagnoses (HR 1.42; 95% CI: 1.26–1.61; p<0.001), and HL levels (HR 1.34; 95% CI: 1.01–1.79; p<0.05). Length of stay and the number of chronic conditions were not found to be significant predictors of ED visits. Nursing interventions were not significant predictors of mortality; however, they were protective regarding hospital readmissions (HR 0.75; 95% CI: 0.67–0.84; p<0.001) and ED visits (HR 0.61; 95% CI: 0.53–0.69; p<0.001). Conclusions: HL and nursing complexity were predictors across several outcomes, while nursing interventions reduced hospital readmissions and ED visits. These results could be used to promote personalized nursing care covering strategies to address inadequate HL in atrial fibrillation.