Health Literacy Interventions and Outcomes in Patients With Atrial Fibrillation

BACKGROUND: Health literacy interventions have the potential to improve health outcomes in patients with atrial fibrillation (AF). OBJECTIVES: This meta-analysis aimed to investigate the relationship between health literacy interventions and patient knowledge, patient action, and clinical outcomes in patients with AF. METHODS: MEDLINE, EMBASE, Web of Science, CINAHL, Emcare, Cochrane Library, and Google Scholar were searched for studies reporting health literacy interventions in patients with AF till August 30, 2024. RESULTS: Of the 3,889 records identified, 53 studies were included in the final review. There is a shift in the trajectory of health literacy interventions from face-to-face to digital delivery. A large positive effect (n = 12; Hedges' g = 0.95 [0.55-1.35]) was observed for knowledge outcomes, with benefits for both digital and face-to-face interventions and uncertainty of sustained improvement beyond 12 months. There was an improvement in patient action outcomes (n = 11; Hedges' g = 0.54 [0.16-0.92]), driven by a moderate-sized effect for treatment adherence (n = 6; Hedges' g = 0.61 [0.19-1.03]) but an uncertain effect on self-efficacy. A small number of studies incorporated interventions, such as rhythm monitoring and reminder texts for patients, as well as software for doctors, to improve adherence to recommended guidelines. For clinical outcomes, health literacy interventions were associated with lower emergency department visits (n = 4; OR: 0.69 [0.48-0.98]), hospitalization (n = 14; OR: 0.56 [0.44-0.73]), and mortality (n = 16; OR: 0.64 [0.49-0.82]). CONCLUSIONS: Health literacy interventions are demonstrating a trajectory toward a digital mode, extending beyond patient education, and are associated with gains in AF knowledge, treatment adherence, and improved survival.