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Heart's Not Healthy? Recouping Tips

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When it comes to health, the better-informed patient does better—Duh!

What is a patient to do to reverse or ameliorate heart failure, that is, besides taking meds?

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Context Little is known about the effects of low health literacy among patients with heart failure, a condition that requires self-management and frequent interactions with the health care system.

Objective To evaluate the association between low health literacy and all-cause mortality and hospitalization among outpatients with heart failure.

Design, Setting, and Patients Retrospective cohort study conducted at Kaiser Permanente Colorado, an integrated managed care organization. Outpatients with heart failure were identified between January 2001 and May 2008, were surveyed by mail, and underwent follow-up for a median of 1.2 years. Health literacy was assessed using 3 established screening questions and categorized as adequate or low. Responders were excluded if they did not complete at least 1 health literacy question or if they did not have at least 1 year of enrollment prior to the survey date.

Main Outcome Measures All-cause mortality and all-cause hospitalization.

Results Of the 2156 patients surveyed, 1547 responded (72% response rate). Of 1494 included responders, 262 (17.5%) had low health literacy. Patients with low health literacy were older, of lower socioeconomic status, less likely to have at least a high school education, and had higher rates of coexisting illnesses. In multivariable Cox regression, low health literacy was independently associated with higher mortality (unadjusted rate, 17.6% vs 6.3%; adjusted hazard ratio, 1.97 [95% confidence interval, 1.3-2.97]; P = .001) but not hospitalization (unadjusted rate, 30.5% vs 23.2%; adjusted hazard ratio, 1.05 [95% confidence interval, 0.8-1.37]; P = .73).

Conclusion Among patients with heart failure in an integrated managed care organization, low health literacy was significantly associated with higher all-cause mortality.

•   Peterson PN, Shetterly SM, Clarke CL. et al. "Health Literacy and Outcome Among Patients With Heart Failure." 20111;305(16):1695-1701.

Point of this piece

Like the song, paraphrased, "The Gambler," you gotta know when to walk, when to exercise, how to handle stress, diet, and so forth.  In heart failure, for example, the knowledgeable patient does better.  Here follow three excellent relevant references from Harvard University's reports and press:

Responses to stress-- Healthy or Unhealthy

How are you or yours dealing with stressors and stressful times? Some ways may be healthy, such as communicating with friends, working at a hobby, or just curling up in bed early. But, other ways may not be so harmless or forgiving. A recent Harvard publication, offers that “All too often, people self-medicate or turn to other unhealthy behaviors in an attempt to relieve pressure they feel. They may do so in a variety of ways. For example:

•   Watching endless hours of TV

•   Withdrawing from friends or partners or, conversely jumping into a frenzied social life to avoid facing problems

•   Overeating or weight gain

•   Undereating or weight loss

•   Sleeping too much

•   Drinking too much alcohol

•   Lashing out at others in emotionally or physically violent outbursts

•   Taking up smoking or smoking more than usual

•   Taking prescription or over-the-counter drugs that promise some form or relief, such as sleeping pills, muscle relaxants, or anti-anxiety pills

•   Taking illegal or unsafe drugs

Becoming aware of how you typically handle stress can help you make healthy choices." However, one cannot totally avoid stress. In fact, just waking up is a stressor one needs on a daily basis.  For further information, google the Special Health Report from Harvard Medical School on the topic of "Stress Management."

"Mind Your Heart: A Mind/Body Approach to Stress Management, Exercise, and Nutrition for Heart Health" [Note: <> failed to work 5/27/16]

Based on the innovative Cardiac Wellness Program at the Mind/Body Medical Institute, founded by pioneering physician and researcher Herbert Benson, M.D., Mind Your Heart offers a balanced and holistic approach to heart health that combines lifestyle changes with cutting-edge medical procedures.

While the authors do discuss medication and surgical treatments, Casey and Benson emphasize the importance of risk factors such as depression, anger, hostility, decreased social support, physical inactivity, and poor nutrition then outline self-care strategies that help change these behaviors. With this program, you can lower your blood pressure and cholesterol, lose weight, increase physical fitness, and help prevent and manage heart disease. Also included in Mind Your Heart are a number of strategies to better manage stress.  " style="font-family: verdana, geneva, sans-serif; font-size: 11px; ">Learn more »  [Note: <> failed to work 5/27/16]

Healthy Eating for a Healthy Heart

Despite major advances in drugs and medical treatments, maintaining a healthy diet, being physically active, and not smoking are still the best approaches to preventing heart disease. Improving your diet lowers your risk for heart disease in many ways, including helping to lower high cholesterol, blood pressure, and blood sugar and insulin levels, as well as preventing obesity and improving the function of your heart and blood vessels. Fortunately, a heart-healthy diet is relatively easy to... Learn more »

Blood Pressure control DOES make a difference


IMPORTANCE:  In chronic kidney disease (CKD), strict blood pressure control is not necessarily effective reducing mortality; in fact it might have the opposite efect!


To compare the outcomes associated with a treated systolic blood pressure (SBP) of less than 120 mm Hg vs those associated with the currently recommended SBP of less than 140 mm Hg in a national CKD database of US veterans.


Historical cohort study using a nationwide cohort of US veterans with prevalent CKD, estimated glomerular filtration rate less than 60 mL/min/1.73 m2, and uncontrolled hypertension, who then received 1 or more additional blood pressure medications with evidence of a decrease in SBP. Propensity scores were calculated to reflect each individual's probability for future SBP less than 120 vs 120 to 139 mm Hg.


The effect of SBP on all-cause mortality was evaluated by the log-rank test, and in Cox models adjusted for propensity scores.


Using a database of 651 749 patients with CKD, we identified 77 765 individuals meeting the inclusion criteria. A total of 5760 patients experienced follow-up treated SBP of less than 120 mm Hg and 72 005 patients had SBP of 120 to 139 mm Hg. During a median follow-up of 6.0 years, 19 517 patients died, with 2380 deaths in the SBP less than 120 mm Hg group (death rate, 80.9/1000 patient-years [95% CI, 77.7-84.2/1000 patient-years]) and 17 137 deaths in the SBP 120 to 139 mm Hg group (death rate, 41.8/1000 patient-years [95% CI, 41.2-42.4/1000 patient-years]; P < .001). The mortality hazard ratio (95% CI) associated with follow-up SBP less than 120 vs 120 to 139 mm Hg was 1.70 (1.63-1.78) after adjustment for propensity scores.


Our results suggest that stricter SBP control is associated with higher all-cause mortality in patients with CKD. Confirmation of these findings by ongoing clinical trials would suggest that modeling of therapeutic interventions in observational cohorts may offer useful guidance for the treatment of conditions that lack clinical trial data

Kovesdy CPLu JL2Molnar MZMa JZ,​ et al. "Observational Modeling of Strict vs Conventional Blood Pressure Control in Patients With Chronic Kidney Disease." JAMA Intern Med. 2014 Aug 4. doi: 10.1001/jamainternmed.2014.3279. [Epub ahead of print]