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Introduction Low health literacy (HL) is consistently associated with worse health outcomes. Routine clinical screening with available instruments is impractical because of added time and effort. Prior findings suggested that signature time may be a reliable alternative measure of HL among general medicine patients. Methods Our aim was to assess the screening performance of signature time and explore optimal thresholds for identifying patients with limited HL in a chronically anticoagulated population. English-speaking patients receiving long-term anticoagulation therapy were recruited. HL was assessed using the Short Test of Functional Health Literacy in Adults (STOFHLA). Signature time was measured using a stopwatch. Logistic regression models and receiver-operating characteristic (ROC) curves were used to evaluate the association and accuracy of signature time compared to HL, respectively. Results Of 139 enrolled patients, mean age was 60.1 years, 70.5% were African-American, 48.9% reported < $25,000 income, and 27.3% had marginal or inadequate HL. Overall, median time to sign was 6.1 s. Signature time was longest with inadequate HL (median 9.5 s) compared to adequate HL (5.7 s; p < 0.01). Longer signature time was significantly associated with lower HL after adjusting for age and education (aOR 0.77, 95% CI: 0.68–0.88, p < 0.01). Signature time demonstrated high accuracy (area under the curve [AUC] > 0.8) in identifying HL levels. Thresholds of 5.1 s and 9.0 s showed appropriate screening performance in distinguishing patients with adequate vs. marginal and marginal vs. inadequate HL, respectively. Conclusion Signature time demonstrated strong screening performance and may offer a quick and practical approach to assessing HL among patients receiving long-term anticoagulation management.

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type of comorbidity (non-cardiovascular, cardiovascular and mixed). Descriptive statistics were used to describe the relationship between comorbidity and variables of interest. Age-stratified multivariate Cox Proportional Hazards models were used to assess the association of comorbidity with all-cause mortality overall and by age strata (#60, 61-70,71-80, and .80 years old). Results: The study included 926 HF subjects: mean age was 68 years, and 42% died during follow-up. The age-specific allcause mortality rates of subjects #60, 61 -70, 71 -80, and . 80 years of age, were 20%, 28%, 48% and 82% respectively. In the overall cohort, subjects with non-cardiovascular and mixed comorbidities had a higher risk of all-cause mortality than those with cardiovascular comorbidities (HR=2.0,95%CI=1.2-3.2 and HR=1.6, 95% CI=1.1-2.2 respectively). The risk of all-cause mortality for mixed comorbidities compared to cardiovascular comorbidities was higher for subjects 61-70 years of age (HR=5.4, 95% CI=1.4-19.7), but lower for subjects .80 years of age (HR=0.5,95% CI=0.4-0.8). Conclusions: We found an association of higher risk of all-cause mortality with mixed and non-cardiovascular comorbidities compared to cardiovascular comorbidities in different age-groups. These findings may help to inform clinicians and health care providers on the management of HF patients with comorbidities and of different age groups.