Impact of health literacy in patients with cardiovascular diseases: A systematic review and meta-analysis

Abstract Objective To clarify the impacts of health literacy on mortality, readmission, and quality of life (QOL) in the secondary or tertiary prevention of cardiovascular diseases (CVD) through a meta-analysis. Methods Six electronic databases were searched on June 11, 2020. Observational studies involving patients with CVD, health literacy as an exposure factor and mortality, readmission, or QOL as outcomes were included in this study. Two researchers screened the retrieved articles and extracted data independently. The meta-analysis calculated the pooled relative risk of mortality and readmission. We also assessed the body of evidence based on Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results Following screening of 1616 studies, 16 observational studies were included. The mean rate of low health literacy was 32.8%. All studies focusing on QOL showed significant impacts of health literacy. Pooled relative risk was 1.621 (95% confidence interval: 1.089–2.412) for mortality and 1.184 (95% confidence interval: 1.035–1.355) for readmission, indicating significant effects of health literacy. GRADE assessment showed “LOW” certainty for each outcome. Conclusion Low health literacy was significantly associated with increased mortality and hospital readmission and decreased QOL in patients with CVD. Practice implications Considering low health literacy in clinical practice is very important to improve prognosis of CVD patients.