Self-reported difficulty reading small print and in-hospital behavioral change in older adults with cardiovascular disease: Implications for post-discharge cardiovascular outcomes

OBJECTIVES: Visual dysfunction may hinder patient education and self-care in older patients with cardiovascular disease (CVD); however, its association with behavioral change during hospitalization and subsequent cardiovascular prognosis remains unclear. This study investigated whether self-reported difficulty reading small print is associated with transtheoretical model (TTM) stage progression during hospitalization and whether such change predicts post-discharge outcomes. METHODS: This prospective multicenter cohort study enrolled older patients who underwent cardiac rehabilitation during hospitalization. Visual dysfunction was assessed by self-reporting of difficulty reading small print. Behavioral change was evaluated using the TTM. The primary outcome was unplanned rehospitalization due to major adverse cardiovascular and cerebrovascular events (MACCE) within one year. Multivariable logistic regression identified factors associated with TTM improvement, and Cox proportional hazards models were applied to examine the association between TTM improvement and MACCE rehospitalization. RESULTS: Among 351 included patients, 31.9% had difficulty reading small print. After multivariable adjustment, difficulty reading small print was independently associated with lower odds of TTM improvement (odds ratio, 0.31; p=0.006). Patients achieving TTM improvement had a significantly lower risk of MACCE rehospitalization after adjustment for age, sex, institution, heart failure, renal disease, and TTM stage at discharge (hazard ratio, 0.37; p = 0.042). CONCLUSIONS: Self-reported difficulty reading small print was independently associated with reduced TTM stage improvement during hospitalization, and TTM stage improvement predicted a lower risk of MACCE rehospitalization. These findings highlight the importance of focusing on the behavioral change process during hospitalization and incorporating visual considerations into behavioral support strategies for secondary prevention in older CVD patients.