Inadequate health literacy was associated with higher odds of Major Adverse Cardiovascular Events (OR=1.721) and medication non-adherence (OR=7.864) among cardiovascular disease patients, with latent profile analysis identifying six distinct health literacy profiles linked to differential outcomes.
Key Findings
Results
Inadequate health literacy was associated with significantly higher odds of Major Adverse Cardiovascular Events (MACE) in cardiovascular disease patients.
In fully adjusted models, inadequate health literacy was associated with higher odds of MACE (OR=1.721, 95% CI 1.143–2.593)
42.3% of patients had inadequate health literacy
172 patients experienced MACE during the 6-month follow-up period
Health literacy was assessed using the Brief Health Literacy Screen (BHLS)
Study enrolled 1,150 patients, of whom 951 completed follow-up
Results
Inadequate health literacy was strongly associated with medication non-adherence in cardiovascular disease patients.
In fully adjusted models, inadequate health literacy was associated with higher odds of medication non-adherence (OR=7.864, 95% CI 4.298–14.388)
Medication adherence was measured using the Morisky Medication Adherence Scale (MMAS-8)
Follow-up was conducted at 6 months post-enrollment
This association was substantially stronger than the association between health literacy and MACE
Results
Higher scores on BHLS Item 1 (confidence in completing medical forms) were independently associated with lower odds of MACE.
Higher BHLS Item 1 scores were associated with lower odds of MACE (OR=0.660, 95% CI 0.517–0.842)
BHLS Item 1 specifically relates to patients' confidence in completing medical forms
This item-level analysis suggests that specific components of health literacy may differentially predict cardiovascular outcomes
Authors recommend interventions that strengthen patients' confidence in completing medical forms and understanding written information
Results
Latent profile analysis identified six distinct health literacy profiles among cardiovascular disease patients, with the lowest profile associated with substantially higher odds of MACE.
LPA was performed using the three BHLS items
Model selection was based on AIC, BIC, entropy, and the bootstrap likelihood ratio test
Six distinct latent profiles of health literacy were identified
The lowest health literacy profile had higher odds of MACE (OR=2.732, 95% CI 1.544–4.833)
The OR for MACE in the lowest LPA profile (2.732) was higher than the OR for the binary inadequate health literacy classification (1.721), suggesting profile-based analysis captures additional risk differentiation
Methods
This was a single-center prospective cohort study conducted at a tertiary hospital in Chongqing, China, with a notable attrition rate over 6 months of follow-up.
Study was conducted from 2022 to 2023 at a tertiary hospital in Chongqing
1,150 patients were enrolled but only 951 completed 6-month follow-up, representing approximately 17.3% attrition
Logistic regression was used to assess associations with prognosis and adherence
The study design was a single-center prospective cohort
What This Means
This research suggests that how well patients understand health information — their 'health literacy' — has a significant impact on their outcomes after being diagnosed with cardiovascular disease. In a study of over 1,100 heart disease patients followed for six months at a hospital in China, researchers found that patients who had difficulty understanding health-related information were nearly twice as likely to experience serious cardiac events (such as heart attack or stroke) compared to those with adequate health literacy. Even more strikingly, patients with low health literacy were nearly eight times more likely to not take their medications as prescribed.
The researchers used a technique called latent profile analysis to go beyond a simple 'adequate vs. inadequate' classification and identify six distinct groups of patients based on their health literacy patterns. The group with the lowest health literacy scores had more than 2.7 times the odds of experiencing a major adverse cardiovascular event. One specific aspect of health literacy — a patient's confidence in filling out medical forms — was particularly linked to better heart outcomes, with higher confidence associated with lower risk of serious cardiac events.
This research suggests that health literacy is a meaningful and measurable factor that influences both how well heart disease patients take their medications and how their disease progresses over time. The findings point to a practical opportunity: healthcare programs that help patients better understand written medical information and feel more confident navigating health paperwork could potentially improve medication adherence and reduce serious cardiac complications in this population.
Liu Y, Chen J, Xiao L, Yang Y, Zhang F. (2026). Effect of health literacy on medication adherence and prognosis among patients with cardiovascular disease: a latent profile analysis.. Health education research. https://doi.org/10.1093/her/cyag023