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Illness perceptions and health literacy are strongly associated with health-related quality of life, anxiety and depression in patients with coronary heart disease: results from the EUROASPIRE V cross-sectional survey.

AIMS
To 1) Describe the sociodemographic and risk factor profiles of a sample of patients with coronary disease, 2) Explore associations between illness perceptions and health literacy with sociodemographic characteristics and risk factors, health-related quality of life, anxiety and depression.


METHODS AND RESULTS
Conducted as part of the ESC Prevention of CVD Project and EUROASPIRE V survey, patients were consecutively and retrospectively identified 6 months to 2 years after an acute event or elective procedure from 12 countries and interviewed. 3,408 participants (76% male, mean age 64 years) were recruited, 16% were smokers, 38% obese, 60% physically inactive and 41% hypertensive. 40% had attended cardiac rehabilitation. More threatening illness perceptions were associated with female gender (P < 0.0001), lower income (P < 0.0001), lower education (P = 0.02), obesity (P < 0.0001), sedentary behaviour (P < 0.0001) and diabetes (P < 0.0001). Poorer health literacy was associated with obesity (P = 0.02) and sedentary behaviour (P = 0.0001). Threatening illness perceptions were strongly associated with anxiety, depression and poorer ratings of health-related quality of life after multivariable adjustment (all P < 0.001). Poor health literacy was associated with anxiety and depression (P < 0.0001) and poorer ratings of health-related quality of life (HeartQol scores P = 0.03). Results were consistent across regions of Europe, age, gender and socioeconomic strata.


CONCLUSIONS
Interventions like cardiac rehabilitation should be targeted at vulnerable groups given the strong associations between more threatening illness perceptions, lower health literacy, lower health related quality of life, and higher levels of anxiety and depression. The delivery and content of these interventions should be accessible for those with low health literacy.