Cognitive function and health literacy are independently associated with heart failure knowledge.

The analysis used one time point, so it cannot show whether low literacy or cognitive problems caused less knowledge, or whether less knowledge came first. Cognition was screened with one mental status test, not a full battery, so specific cognitive problems were not identified. The free recall knowledge items were not validated and had low internal consistency, so they were only descriptive. Participants were English-speaking adults from two healthcare systems in northeast Ohio, mostly male and white, so the results may not apply to other groups. Prior heart failure education was not assessed, and some patients were classified by self-reported symptoms at baseline, including class I or IV despite enrollment criteria of class II or III.

Do not read this as evidence that improving literacy or cognition will improve heart failure knowledge or outcomes. The study measured associations at one time point and did not test any intervention.