Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association’s mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.

Atrial fibrillation (AF) is of public health importance and profoundly increases morbidity, mortality and health-related expenditures. Morbidities include the increased risks of cardiovascular outcomes such as heart failure and stroke, and the deleterious effects on quality of life, functional status and cognition. The clinical epidemiology of AF, its risk factors and outcomes, have been extensively investigated. Genetic advances over the last decade have facilitated the identification of mutations and common polymorphisms associated with AF. Metabolomics, proteomics and other “omics” technologies have only recently been applied to the study of AF, and have not yet been systematically investigated. Systems biology approaches, while still in their infancy, offer the promise of providing novel insights into pathways influencing AF risk. In the present review, we address the current state of the epidemiology and genomics of AF. We seek to emphasize how epidemiology and “omic” advances will contribute towards a systems biology approach that will help to unravel the pathogenesis, risk stratification, and novel targets for AF therapies. Our purpose is to articulate questions and challenges that hinge on integrating novel scientific advances in the epidemiology and genomics of AF. As a reference we have provided a glossary in the inset box.

Atrial fibrillation (AF) is a common cardiac arrhythmia with significant adverse outcomes and high social and medical costs.¹ In the United States, AF affects approximately 1% of the adult population and more than 5% of those 65 years and older.^2,3 Atrial fibrillation has been associated with increased risks of stroke by 5.0-fold, heart failure by 3.0-fold, and mortality by 2.0-fold.^4-7 The study of AF and its associated clinical adverse outcomes has been conducted predominantly in cohorts with participants of mostly white race.