Health literacy and coronary artery disease: A systematic review

•This review explored the role of health literacy in the care of CAD patients.•The literature on health literacy in CAD patients is very limited.•The most used health literacy screening instruments were REALM and TOFHLA.•Low HL was associated with several outcomes, including hospital readmissions.•Research needed to test the effectiveness of health literacy interventions in CAD. Identify health literacy (HL) screening instruments available to CAD patients; describe the prevalence of low HL; explore the predictors of low HL; and, identify the association between HL, health behaviors, and outcomes among these patients. A literature search of electronic databases was conducted for published articles from database inception to February 2017. Eligible articles included the assessment of HL in CAD patients. Health behaviors and outcomes included diet, exercise, smoking, medication use, hospital readmission, knowledge, health-related quality of life (HRQoL), and psychosocial indicators. Overall, ten articles were included, of which two were RCTs, and seven were considered “good” quality. The most used screening instruments were REALM and TOFHLA. The average prevalence of low HL was 30.5%. Low HL participants were more likely to be older, male, from a non-white ethnic group, have many CVD comorbidities, lower educational level, disadvantaged socioeconomic position, and less likely to be employed. Low HL was consistently associated with hospital readmissions, low HRQoL, higher anxiety and lower social support. The literature on HL in CAD patients is very limited. Healthcare providers should start adopting strategies that can potentially mitigate the impact of low HL in the care of CAD patients.