Abstract
ObjectiveTo explore the association between health literacy and the risk of cardiovascular disease (CVD), and to assess the differential effects by health literacy level of a nurse-coordinated secondary prevention program (NCPP) in patients with coronary artery disease (CAD).MethodsData were collected in two medical centres participating in the RESPONSE trial (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists). CVD risk profiles were assessed at baseline and 12-month follow-up using the Systematic Coronary Risk Evaluation (SCORE). Health literacy was assessed by the short Rapid Estimate of Adult Literacy in Medicine (REALM-D) and the Newest Vital Sign (NVS-D); self-reported health literacy was evaluated by the Set of Brief Screening Questions (SBSQ-D).ResultsAmong 201 CAD patients, 18% exhibited reading difficulties, 52% had difficulty understanding and applying written information, and 5% scored low on self-reported health literacy. Patients with low NVS-D scores had a higher CVD risk [mean SCORE 5.2 (SD 4.8) versus 3.3 (SD 4.1), p < 0.01]. Nurse-coordinated care seemed to reduce CVD risk irrespective of health literacy levels without significant differences.ConclusionInadequate health literacy is prevalent in CAD patients in the Netherlands, and is associated with less favourable CVD risk profiles. Where many other forms of CVD prevention fail, nurse-coordinated care seems to be effective among patients with inadequate health literacy.
Highlights
Patients with manifest coronary artery disease (CAD) are at high risk of recurrent coronary events and death
A larger sample is needed to confirm the significance of the differences in the effectiveness that we found between health literacy groups
Inadequate health literacy is highly prevalent in patients with documented CAD, and is associated with adverse risk profiles
Summary
Patients with manifest coronary artery disease (CAD) are at high risk of recurrent coronary events and death. Secondary prevention, consisting of a healthy lifestyle and optimal drug therapy, can reduce this risk [1]. The use of such evidence-based secondary prevention is far from optimal [2]. It is unknown whether specialised secondary prevention strategies as recommended by the current guidelines E. multidisciplinary cardiac rehabilitation, preventive programs for therapy optimisation, adherence and risk factor management, and nurse and allied health professional led programs) are effective for all CAD patients, in particular those with low health literacy [1]. Lower health literacy is associated with less well controlled blood pressure in primary care patients with hypertension and heart disease [5] and worse adherence to cardiovascular preventive drugs [6].
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