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Low Health Literacy Linked to Early Death for Cardiovascular Patients


The study examined several social factors that can affect health outcomes when patients are hospitalized for cardiovascular events.

Patients who struggle to access and understand health information are more likely to die within a year of being hospitalized for a cardiovascular event, a new study has found.

Researchers from Vanderbilt University Medical Center reported that regardless of how sick the patients were, social factors such as health literacy and support after leaving the hospital are just as important to survival after being treated for cardiovascular disease. Their findings, based on data from 3000 patients, appear today in Mayo Clinic Proceedings.

The patients were followed after being hospitalized for acute coronary syndrome, heart failure, or both. The study considered how sick the patients were, whether they had comorbidities, what type of cardiovascular disease, and any recent hospitalizations, as well as factors like support at home, medication adherence, smoking behavior, and physical activity.

But the study also asked patients about their own perceived health competence—meaning how well they thought they could take care of themselves.

Of the 2977 patients discharged from the hospital (60% male; mean age, 61 years), 17% to 23% had inadequate health literacy, depending on the measure, and 10% died within 1 year.

“The mechanisms that were linking lower health literacy and premature mortality were not only how sick the patient was but also things patients have control over, like health behaviors and how much they believe that they can change their outcomes,” study author Lindsay Mayberry, PhD, an assistant professor of Medicine at Vanderbilt, said in a statement.

Screening for patients’ health literacy when they enter the hospital can identify those at risk, and health systems must take steps to deliver information in ways that patients understand, she said.

“Your health behaviors and this sense of control over your health outcome, independent of how sick you are, are really important,” Mayberry said. “Increasing physical activity, stopping smoking, and reducing alcohol intake are really important things that patients can control, especially after a hospitalization for cardiovascular disease.”


Mayberry LS, Schildcrout JS, Wallston KA, et al; Vanderbilt Inpatient Cohort Study. Health literacy and 1-year mortality: mechanisms of association in adults hospitalized for cardiovascular disease [published online November 7, 2018]. Mayo Clin Proceed. doi: 10.1016/j.mayocp.2018.07.024.

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