Does health literacy predict cardiac rehabilitation attendance and completion rates in patients after their first myocardial infarction?

Abstract

Aim: To explore whether there is an association between health literacy, an important determinant of heath that affects people’s ability to process information, and cardiac rehabilitation (CR) attendance and completion rates following acute myocardial infarction (AMI). Method: A cross-sectional analysis of CR data in ENHEARTEN study--a multicentre, prospective observational study of adults with first AMI (n=440). Health literacy was measured using the 12-item European health literacy survey (HLS-12) and four scales of health literacy questionnaire (HLQ3, actively managing my health; HLQ4, social support for health; HLQ6, engage with health care providers; and HLQ7, navigate the health care system). CR attendance and cardiac self-efficacy data were obtained from electronic medical records and/or self-reported by patients at 6 months following AMI. The relationship between health literacy and CR attendance and cardiac self-efficacy was analysed using univariate logistic regression. Results: CR attendance was associated with greater age (60.7 vs 57.9 years, p=0.01) and use of private health insurance (43.7% vs 33.1%, p=0.03) and less likely to have depression symptoms (15.9% vs 30.6%, p<0.001). CR attenders demonstrated higher HLQ3 (2.8 vs 2.6, p=0.01) and HLQ4 (3.0 vs 3.0, p=0.04) scores. At 6 months follow-up, patients who attended CR reported higher cardiac self-efficacy and scored significantly higher in all HLQ scores. Conclusions: This study highlights the important role of health literacy, socioeconomic factors and mental health in CR attendance. Further studies should explore how to implement targeted interventions for patients with low health literacy to improve their CR attendance and long-term health outcomes.