Public recognition of major signs and symptoms of heart attack: seventeen states and the US Virgin Islands, 2001

Recognition of Early Cardiovascular Disease Symptoms in Hypertensive and Dyslipidemic Individuals of Icheon, Korea: Insights into Educational Levels and Health Literacy

The study aimed to explore the relationship between the presence of hypertension or dyslipidemia and the recognition of early symptoms of cardiovascular diseases (CVD), particularly acute myocardial infarction (AMI) and stroke. It is crucial for individuals with hypertension or dyslipidemia to recognize early symptoms of AMI and stroke, as timely and appropriate intervention can lead to favorable health outcomes. The study enrolled 104 participants aged 19 and above who are current residents of the Icheon region, Gyeonggi, Korea. The assessment of early symptoms of AMI and stroke utilized adapted items from the Korea Community Health Survey. In consideration of health literacy and education attainment, logistic regression analyses were conducted. While there was no significant association between hypertension and awareness of AMI or stoke symptoms, individuals with dyslipidemia demonstrated enhanced recognition of specific AMI symptoms, such as 'sudden chest pain or pressure' and 'sudden feeling of breathlessness'. No significant associations were observed between hypertension or dyslipidemia and awareness of stroke symptoms. The study emphasized the significance of targeted health education programs for individuals with chronic conditions to enhance their awareness of early symptoms of AMI and stroke.

Age and healthy lifestyle behavior's disparities and similarities on knowledge of myocardial infarction symptoms and risk factors among public and outpatients in a resource-limited setting, cross-sectional study in greater Gaborone, Botswana

OBJECTIVES

In this cross-sectional study from Botswana, we investigated knowledge of myocardial infarction (MI) symptoms and risk factors among the general public and outpatients with MI risk factors based on age and lifestyle behaviors, in addition to assessing associations with sociodemographic and MI risk factors.

METHOD

Open-ended questionnaires about 8 MI symptoms and 10 risk factors, were administered by research assistants to a representative selection of outpatients (n = 525) and the public (n = 2248). Weight and height were measured in all participants and BMI was calculated. Knowledge scores were compared between the two groups. We examined whether sociodemographic and MI risk factors had impact on the scores. Analyses were further adjusted for lifestyle behavior (smoking status, dietary status and physical activities).

RESULTS

The valid response rate was 97.9% comprising 97.8% for the public (n = 2199) and 98.1% for outpatients (n = 515). Public respondents (35.2 ± 12.3 years) were younger than outpatients (38.5 ± 12.6 years). The public comprised 56.9% females while outpatients 54.6%. In general, outpatients had higher knowledge of MI symptoms than the public, with mean scores ± SD of 3.49 ± 2.84 vs 2.80 ± 2.54. Outpatients also had higher knowledge score of MI risk factors than the public, with mean scores, 5.33 ± 3.22 vs 3.82 ± 3.07. For MI symptoms, outpatients were more aware than the public for chest pains among all ages, for arm pain/ numbness, neck/ jaw pain radiating to/ from chest, and feeling sick or looking pallor on the skin among those aged 35-49 years. Among both the public and outpatients, lower knowledge of both MI symptoms and risk factors was associated with primary education, not residing/working together, history of hypertension, no history of heart disease/stroke, and obesity. There were similarities and disparities on MI knowledge among respondents with various numbers of healthy lifestyle behaviours.

CONCLUSION

Results call for urgent educational campaigns on awareness and knowledge of MI and using strategies based on age and lifestyle behavior.

Latent class cluster analysis of knowledge on acute myocardial infarction in community residents: a cross-sectional study in Tianjin, China

OBJECTIVE

Public knowledge of early onset symptoms and risk factors (RF) of acute myocardial infarction (AMI) is very important for prevention, recurrence and guide medical seeking behaviours. This study aimed to identify clusters of knowledge on symptoms and RFs of AMI, compare characteristics and the awareness of the need for prompt treatment.

DESIGN

Multistage stratified sampling was used in this cross-sectional study. Latent GOLD Statistical Package was used to identify and classify the respondent subtypes of the knowledge on AMI symptoms or modifiable RFs. Multivariable logistic regression was performed to identify factors that predicted high knowledge membership.

PARTICIPANTS

A structured questionnaire was used to interview 4200 community residents aged over 35 in China. 4122 valid questionnaires were recovered.

RESULTS

For AMI symptoms and RFs, the knowledge levels were classified into two or three distinct clusters, respectively. 62.7% (Symptom High Knowledge Cluster) and 39.5% (RF High Knowledge Cluster) of the respondents were able to identify most of the symptoms and modifiable RFs. Respondents who were highly educated, had higher monthly household income, were insured, had regular physical examinations, had a disease history of AMI RFs, had AMI history in immediate family member or acquaintance or had received public education on AMI were observed to have higher probability of knowledge on symptoms and RFs. There was significant difference in awareness of the prompt treatment in case of AMI occurs among different clusters. 'Calling an ambulance' was the most popular option in response of seeing others presenting symptoms of AMI.

CONCLUSIONS

A moderate or relatively low knowledge on AMI symptoms and modifiable RFs was observed in our study. Identification of Knowledge Clusters could be a way to detect specific targeted groups with low knowledge of AMI, which may facilitate health education, further reduce the prehospital delay in China and improve patient outcomes.

Which health-related reasons lead to prehospital emergency care and how does subjective emergency status connect to subsequent care?

Objectives/Background

In many countries, the use of emergency medical services (EMS) increases steadily each year. At the same time, the percentage of life-threatening complaints decreases. To redesign the system, an assessment and consideration of the patients’ perspectives is helpful.

Methods

We conducted a paper-based survey of German EMS patients who had at least one case of prehospital emergency care in 2016. Four health insurance companies sent out the questionnaire to 1312 insured persons. We linked the self-reported data of 254 respondents to corresponding claims data provided by their health insurance companies. The analysis focuses a.) how strongly patients tend to call EMS for themselves and others given different health-related scenarios, b.) self-perceived health complaints in their own index case of prehospital emergency care and c.) subjective emergency status in combination with so-called “objective” characteristics of subsequent EMS and inpatient care. We report principal diagnoses of (1) respondents, (2) 57,240 EMS users who are not part of the survey and (3) all 20,063,689 inpatients in German hospitals. Diagnoses for group 1 and 2 only cover the inpatient stay that started on the day of the last EMS use in 2016.

Results

According to the survey, the threshold to call an ambulance is lower for someone else than for oneself. In 89% of all cases during their own EMS use, a third party called the ambulance. The most common, self-reported complaints were pain (38%), problems with heart and circulation (32%), and loss of consciousness (17%). The majority of respondents indicated that their EMS use was due to an emergency (89%). We could detect no or only weak associations between patients’ subjective urgency and different items for objective care.

Conclusion

Dispatchers can possibly optimize or reduce the disposition of EMS staff and vehicles if they spoke directly to the patients more often. Nonetheless, there is need for further research on how strongly the patients’ perceived urgency may affect the disposition, rapidness of the service and transport targets.

Edge Artificial Intelligence: Real-Time Noninvasive Technique for Vital Signs of Myocardial Infarction Recognition Using Jetson Nano

The history of medicine shows that myocardial infarction is one of the significant causes of death in humans. The rapid evolution in autonomous technologies, the rise of computer vision, and edge computing offers intriguing possibilities in healthcare monitoring systems. The major motivation of the work is to improve the survival rate during a cardiac arrest through an automatic emergency recognition system under ambient intelligence. We present a novel approach to chest pain and fall posture-based vital sign detection using an intelligence surveillance camera to address the emergency during myocardial infarction. A real-time embedded solution persuaded from “edge AI” is implemented using the state-of-the-art convolution neural networks: single shot detector Inception V2, single shot detector MobileNet V2, and Internet of Things embedded GPU platform NVIDIA’s Jetson Nano. The deep learning algorithm is implemented for 3000 indoor color image datasets: Nanyang Technological University Red Blue Green and Depth, NTU RGB + D dataset, and private RMS dataset. The research mainly pivots on two key factors in creating and training a CNN model to detect the vital signs and evaluate its performance metrics. We propose a model, which is cost-effective and consumes low power for onboard detection of vital signs of myocardial infarction and evaluated the metrics to achieve a mean average precision of 76.4% and an average recall of 80%.

Maternal help seeking about early warning signs and symptoms of pre-eclampsia: A qualitative study of experiences of women and their families

BACKGROUND

Pre-eclampsia is a disorder of pregnancy, where delay in diagnosis and management of warning signs and symptoms can lead to serious morbidity and mortality for women and their infants.

AIM

The aim of this study was to understand factors that influenced women's help seeking in response to the onset of early warning signs and symptoms of pre-eclampsia as well as partners or family members' ability to raise their health concerns with healthcare professionals during the progression of the disorder.

DESIGN AND METHODS

A qualitative narrative research design was used. In depth interviews were used to explore the experiences of 23 women who experienced pre-eclampsia and their families in an urban setting in the UK. Purposive heterogeneity sampling was used to select participants.

RESULTS

Themes associated with help-seeking amongst women included: 1) Risk assessment, 2) Self-monitoring, 3) Organisational constraints. Women categorised as at low risk of hypertensive disorders at their antenatal booking appointment reported a lack of information on pre-eclampsia which affected their ability to seek help as they were unaware of signs and symptoms of the onset of the condition. In contrast women categorised as high risk at this initial appointment considered they were offered too much information about onset of pre-eclampsia, although this facilitated help seeking as they were much more able to recognise signs and symptoms of onset and knew who to contact. Of note is that some women did not experience 'classic' signs and symptoms of pre-eclampsia or were unable to distinguish these from normal signs and symptoms of pregnancy. Some women used self-monitoring, mainly self-initiated and self-taught, of their own blood pressure in order to a) negotiate access to treatment and b) to self-discharge from hospital postnatally.

CONCLUSION

Women and their families need individualised information on signs and symptoms of pre-eclampsia to facilitate timely and appropriate help seeking. Women often used self-monitoring of their blood-pressure to negotiate for help.

Public Awareness of and Action towards Heart Attack Symptoms: An Exploratory Study

Background: Cardiovascular disease (CVD) is still the leading cause of mortality worldwide, and Malaysia is not an exception in this regard. The current research is an attempt to explore symptom awareness of and necessary actions in response to heart attack (HA) among lay public. Methods: This is a cross-sectional study design, and a survey was conducted from May to July 2018 among general public in Kuantan, Pahang state, Malaysia. Results: A total of 393 respondents recruited. Slightly more than one-fourth of the respondents (26.35%) were aware of HA symptoms like pain and/or discomfort in the jaw, neck, or back, while 71.65% showed awareness only of chest pain or discomfort as symptoms. Only 35.6% reported to call an ambulance if they experience someone suffering from HA symptoms, while 82% recognized ≥1 symptom, and only 11.5% recognized all five HA symptoms. Very few respondents, i.e., 1.3% reported awareness about correct recognition of all five HA symptoms. Respondents who had diabetes and hypercholesteremia were more likely to recognize all five HA symptoms. For those who had excellent awareness of all five HA symptoms, the odds ratio (OR) were significantly higher among single respondents (OR 0.023; 95% CI 0.001–0.594), Malay (OR 0.376; 95% CI 0.193–0.733), and those who received information associated with HA (OR 7.540; 95% CI 2.037–27.914). However, those who were aware that HA requires quick treatment had significantly low odds ratio (OR 0.176; 95% CI 0.044–0.710). Conclusions: The awareness of and action towards the signs and symptoms of HA among the public were poor.

Development of questionnaire on awareness and action towards symptoms and risk factors of heart attack and stroke among a Malaysian population

Background

The awareness of symptoms and action towards heart attack and stroke is important to reduce the morbidity and mortality in both developed and developing countries. The aim of this study was to develop a questionnaire on awareness and action towards symptoms and risk factors of heart attack and stroke among lay public in Malaysia. The questionnaire was developed in both English and Bahasa Melayu.

Methods

Primarily the questions were generated in English. Face and content validity were performed by five experts in Pharmacy Practice and Medicine. A translation as per guidelines into Malay language was performed; followed by face-to-face interview of 96 lay public in Kuantan, Pahang, Malaysia. For internal consistency, reliability was assessed utilizing Cronbach’s alpha.

Results

The mean ± SD of the awareness and action towards heart attack symptoms and risk factors was 65.52 ± 6.3, with a good internal consistency (Cronbach’s alpha = 0.75), whereas the mean of the awareness and action towards stroke symptoms and risk factors was 61.93 ± 7.11, with an accepted internal consistency (Cronbach’s alpha = 0.86).

Conclusion

The current validation research showed that the developed questionnaire is valid and reliable for assessing the awareness and action towards symptoms and risk factors of heart attack and stroke among lay public in Malaysia.

Knowledge and Poor Understanding Factors of Stroke and Heart Attack Symptoms

OBJECTIVES

Adequate awareness of cardiovascular disease (CVD) may help in its prevention and control. Therefore, we evaluated knowledge among the general population of stroke and heart attack symptoms and determined the factors associated with poor understanding of CVD.

METHODS

This cross-sectional study included 228,240 adults (102,408 males, 125,832 females) who participated in the 2017 Korean Community Health Survey. Data on sociodemographic characteristics and cognizance of the warning signs of CVD events (stroke and heart attack) were examined. Logistic regression analysis was used to investigate factors associated with poor understanding of CVD.

RESULTS

The stroke and heart attack warning signs that were identified least often by respondents were "sudden poor vision in one or both eyes" (66.1%) and "pain or discomfort in the arm or shoulder" (53.8%). Of the subjects, 19.0% had low CVD knowledge scores (less than 4 out of 10) with males having lower scores than females. In the multivariate analysis, poor understanding of CVD warning signs was significantly associated with older age, male gender, lower education level, lack of regular exercise, unmarried status, unemployment, poor economic status, poor health behaviors (high salt diet, no health screening), poor psychological status (high stress, self-perceived poor health status), and the presence of hypertension or dyslipidemia.

CONCLUSIONS

Specialized interventions, including those based on public education, should focus on groups with less knowledge of CVD.

The association between ethnicity and delay in seeking medical care for chest pain: a systematic review

BACKGROUND

Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity worldwide, and chest pain is one of the most common symptoms of ACSs. A rapid response to chest pain by patients and appropriate management by health professionals are vital to improve survival rates.People from different ethnic groups are likely to have different perceptions of chest pain, its severity and the need for urgent treatment. These differences in perception may contribute to differences in response to chests pain and precipitate unique coping strategies. Delay in seeking medical care for chest pain in the general population has been well documented; however, limited studies have focused on delay times within ethnic groups. There is little research to date as to whether ethnicity is associated with the time taken to seek medical care for chest pain. Consequently, addressing this gap in knowledge will play a crucial role in improving the health outcomes of culturally and linguistically diverse (CALD) patients suffering from chest pain and for developing appropriate clinical practice and public awareness for these populations.

OBJECTIVES

The current review aimed to determine if there is an association between ethnicity and delay in seeking medical care for chest pain among CALD populations.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Patients from different ethnic minority groups presenting to emergency departments (EDs) with chest pain.

TYPES OF EXPOSURE

The current review will examine studies that evaluate the association between ethnicity and delay in seeking medical care for chest pain among CALD populations.

TYPES OF STUDIES

The current review will consider quantitative studies including randomized controlled trials (RCTs), non-RCTs, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies.

OUTCOMES

The current review will consider studies that measure delay time as the main outcome. The time will be measured as the interval between the time of symptom onset and time to reach an ED.

SEARCH STRATEGY

A comprehensive search was undertaken for relevant published and unpublished studies written in English with no date restriction. All searches were conducted in October 2014. We searched the following databases: MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest (health databases only), Informit, Sociological Abstracts, Scopus and Web of Science. The search for unpublished studies included a wide range of 'gray literature' sources including national libraries, digital theses repositories and clinical trial registries. We also targeted specific health research, specialist cardiac, migrant health, and emergency medicine organizational websites and/or conferences. We also checked the reference lists of included studies and contacted authors when further details about reported data was required to make a decision about eligibility.

METHODOLOGICAL QUALITY

Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to being included in the review. Validity was assessed using standardized critical appraisal instruments from the Joanna Briggs Institute. Adjudication was produced by the third reviewer.

DATA EXTRACTION

Data were extracted from included articles by two independent reviewers using the standardized data extraction tool from the Joanna Briggs Institute.

DATA SYNTHESIS

The extracted data were synthesized into a narrative summary. Meta-analysis could not be performed due to the heterogeneity of study protocols and methods used to measure outcomes.

RESULTS

A total of 10 studies, with a total of 1,511,382 participants, investigating the association between ethnicity and delay met the inclusion criteria. Delay times varied across ethnic groups, including Black, Hispanic, Asian, South Asian, Southeast Asian and Chinese. Seven studies reported delay in hours and ranged from 1.90 to 3.10 h. Delay times were longer among CALD populations than the majority population. The other three studies reported delay time in categories of time (e.g. <1, <4 and <6 h) and found larger proportions of later presentations to the EDs among ethnic groups compared with the majority groups.

CONCLUSION

There is evidence of an association between ethnicity and time taken in seeking medical care for chest pain, with patients from some ethnic minorities (e.g. Black, Asian, Hispanic and South Asian) taking longer than those of the majority population. Health promotions and health campaigns focusing on these populations are indicated.

Low level of knowledge of heart attack symptoms and inappropriate anticipated treatment-seeking behaviour among older Chinese: a cross-sectional survey

BACKGROUND

Prehospital delay of acute myocardial infarction (AMI) is common globally, and Hong Kong-home of a rapidly ageing Chinese population-is not an exception. Seeking emergency medical care promptly is important for patients. Treatment-seeking behaviours have been shown to be associated with knowledge of AMI symptoms and specific cultural beliefs. This study aimed to assess the level of knowledge of AMI symptoms and expected treatment-seeking behaviour among older Chinese in Hong Kong.

METHODS

A cross-sectional population-based survey was conducted at the Elderly Health Centres in Hong Kong from March to September 2016. Face-to-face interviews were conducted with a structured questionnaire based on previous studies and local adaptations.

RESULTS

Among 1804 people aged 65 years and above who completed the questionnaire, chest pain (80.2%), palpitations (75.8%) and fainting (71.9%) were the major symptoms recognised as AMI related. Meanwhile, stomach ache (46.9%), coughing (45.4%) and neck pain (40.8%) were recognised as not AMI related. The mean expected discomfort intensity during AMI onset was 7.7 out of 10 (SD=2.1). Regarding the expected treatment-seeking behaviour, seeking non-emergent medical care was the most popular action when AMI symptoms emerged during the day, without chest pain or with lower discomfort intensity, whereas calling an ambulance was the most common option when AMI symptoms emerged at night or with high discomfort intensity.

CONCLUSIONS

To minimise delays in seeking treatment, future health education should focus on increasing the public knowledge of AMI symptoms and the need to call an ambulance during an emergency.

Is denial a maladaptive coping mechanism which prolongs pre-hospital delay in patients with ST-segment elevation myocardial infarction?

OBJECTIVE

During an acute myocardial infarction, patients often use denial as a coping mechanism which may provide positive mood regulating effects but may also prolong prehospital delay time (PHD). However, empirical evidences are still sparse.

METHODS

This cross-sectional study included 533 ST-elevated myocardial infarction (STEMI) patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside. The outcome was assessed using the Cardiac Denial of Impact Scale (CDIS) with the median split as cutoff point. A total of 206 (41.8%) STEMI patients were thus classified as deniers.

RESULTS

Deniers were less likely to suffer from major depression (p=0.04), anxiety (p=0.01) and suboptimal well-being (p=0.01) compared to non-deniers during the last six months prior to STEMI. During STEMI, they were less likely to perceive severe pain strength (p=0.04) and racing heart (p=0.02). Male deniers were also less likely to perceive shortness of breath (p=0.03) and vomiting (p=0.01). Denial was not associated with overall delay time. However, in the time window of 3 to 24h, denial accounted for roughly 40min extra delay (356 vs. 316.5min p=0.02 n=196).

CONCLUSIONS

Denial not only contributes to less suffering from acute heart related symptoms and negative affectivity but also leads to a clinically significant delay in the prevalent group.

Assessing the Associations Between Awareness of Myocardial Infarction Symptoms, Socioeconomic Factors, and Cardiovascular Disease Risk Factors Through Regression Models

There are few studies that consider the association between awareness of symptoms of acute myocardial infarction (MI), socioeconomic factors (household income, sex, race/ethnicity, and educational attainment), and cardiovascular (CVD) risk factors. It is important to understand these associations because there is evidence that suggests that disparities in the awareness of MI symptoms lead to disparities in delays in receiving treatment and outcomes of patients with MI. The study was to determine if there are disparities in the awareness of different MI symptoms among different groups with respect to self-reported race, ethnicity, education, age, and income (i.e., various SES factors) in the presence/absence of modifiable cardiovascular disease risk factors. We utilized the 2003-2009 Behavioral Risk Factor Surveillance Survey, a nationally representative telephone-based survey, to evaluate the relationships between five common symptoms of MI, socioeconomic factors, and four major modifiable CVD risk factors. We found that being college-educated, a higher household income, making $75,000 a year or more, being female, being non-Hispanic White, having hypertension, and exercising regularly were generally associated with a higher probability of being aware of the MI symptoms evaluated in this study. Additionally, awareness that jaw/back/neck pain and feeling weak/light-headed/faint are symptoms of MI were found to be consistently lower compared to that of other MI symptoms, ranging from 50 to 75%, across all SES factors and CVD risk factors. The findings from this study can serve as a useful guide to facilitating targeted educational efforts aimed at improving awareness of MI symptoms that may ultimately reduce disparities in the outcomes of patients at risk for MI.

Patients' knowledge about symptoms and adequate behaviour during acute myocardial infarction and its impact on delay time: Findings from the multicentre MEDEA Study

OBJECTIVE

We aimed to assess whether patients' knowledge about acute myocardial infarction (AMI) has an impact on the prehospital delay-time.

METHODS

This investigation was based on 486 AMI patients who participated in the cross-sectional Munich-Examination-of-Delay-in-Patients-Experiencing-Acute-Myocardial-Infarction (MEDEA) study. A modified German-version of the ACS-Response-Index Questionnaire was used. Multivariate logistic-regression models were used to identify factors associated with knowledge-level as well as the impact of knowledge-level on delay-time.

RESULTS

High AMI-knowledge shortened median delay-time in men (168[92-509] vs. 276[117-1519] mins, p=0.0069), and in women (189[101-601] vs. 262[107-951]mins, p=0.34). Almost half-of-patients (n=284,58%) demonstrated high AMI-knowledge. High-knowledge were independently associated with male-gender (OR=1.47[1.17-1.85]) and General-Practitioner as a knowledge-source (OR=1.42[1.14-1.77]). Old-age (OR=0.87[0.86-0.89]) and previous AMI-history/stent-placement (OR=0.65[0.46-0.93]) were significantly associated with lower-knowledge. Although the majority (476,98%) correctly recognized at least one AMI-symptom, 69(14.2%) patients correctly identified all AMI-symptoms. Additionally, one-in-three believed that heart-attack is always accompanied with severe chest-pain. Elderly-patients and women were more likely to be less-knowledgeable about atypical-symptoms (p=0.006), present with atypical AMI-presentation (p<0.001) and subsequently experience protracted delay-times (p<0.001).

CONCLUSIONS

Knowledge of AMI-symptoms remains to be substandard, especially knowledge of atypical-symptoms. Knowledge is essential to reduce delay-times, but it is not a panacea, since it is not sufficient alone to optimize prehospital delay-times.

Public Response to Chest Pain in Jordan

Background: Chest pain is one of the main and most frequent manifestations of myocardial infarction (MI). Increased level of public awareness on the optimal response to chest pain due to MI attacks is crucial for minimizing its complications and mortality rate.

Aims: The first aim of this investigation was to assess the level of public awareness on their response to acute chest pain. The second aim was to obtain information about self-reported risk factors for coronary heart disease and acute myocardial infarction.

Settings and design: This survey was conducted in various regions of Jordan during the period of July–September 2004. A total of 4194 adults (out of 4500), 2086 males (49.7%) and 2108 females (50.3%) resident in Jordan were included in the sample. The response rate was 92.3%.

Methods: Each individual of the sample who agreed voluntarily to participate in the investigation was asked to report in a questionnaire his/her possible risk factors for MI. Moreover, each person of the sample was asked “What do you do when you suffer from a severe and crushing chest pain that persists for longer than 15 min and radiates to jaws, neck or left shoulder, with sweating and paleness of the face?” The person was asked to choose one option out of 11.

Statistical analysis: The frequency and percentage were determined for each investigated parameter.

Results and conclusion: The highest percentage of respondents had good response by selecting the option “I go to a doctor” while the lowest percentage of respondents showed poor response by choosing the option “I use an antacid”. The remainder of responses was distributed among other options. Excellent awareness was reported by 47% of the sample. Differences in the type of responses were detected when the results were analyzed according to gender, type of job, level of education and ethnicity. Approximately half of the interviewed individuals of the sample had 2–4 clustering risk factors for developing acute MI attacks. Individuals in more than half of the sample had family history of hypertension and diabetes mellitus.

It is concluded that although the type of response to chest pain in Jordan is good–excellent, more improvement is recommended since the risk to MI is relatively high. Community education campaigns may participate in increasing public health education on the optimal response to chest pain of myocardial origin.

The General Public's Awareness of Early Symptoms of and Emergency Responses to Acute Myocardial Infarction and Related Factors in South Korea: A National Public Telephone Survey

BACKGROUND

Prompt treatment affects prognosis and survival after acute myocardial infarction (AMI) onset. This study evaluated the awareness of early symptoms of AMI and knowledge of appropriate responses on symptom occurrence, along with related factors.

METHODS

Participants' knowledge of the early symptoms of and responses to AMI onset were investigated using a random digit dialing survey. We included 9600 residents of 16 metropolitan cities and provinces in Korea.

RESULTS

The proportions of respondents who were aware of early symptoms of AMI ranged from 32.9% (arm or shoulder pain) to 79.1% (chest pain and discomfort). Of the respondents, 67.0% would call an ambulance if someone showed signs of AMI, 88.7% knew ≥1 symptom, 10.9% knew all five symptoms, and 3.1% had excellent knowledge (correct identification of all five AMI symptoms, not answering "Yes" to the trap question, and correctly identifying calling an ambulance as the appropriate response when someone is exhibiting AMI symptoms). The odds ratio (OR) for having excellent knowledge was significantly higher for those who graduated college or higher (OR 3.42; 95% confidence interval [CI], 1.09-10.76) than for those with less than a primary school education, as well as for subjects with AMI advertisement exposure (OR 1.49; 95% CI, 1.10-2.02) and with knowledge of AMI (OR 1.63; 95% CI, 1.16-2.27). The 60- to 79-year-old group had significantly lower OR for excellent knowledge than the 20- to 39-year-old group (OR 0.53; 95% CI, 0.28-0.99).

CONCLUSIONS

Awareness of AMI symptoms and the appropriate action to take after symptom onset in South Korea was poor. Therefore, educational and promotional strategies to increase the overall awareness in the general public, especially in the elderly and those with low education levels, are needed.

Deaf Adolescents' Learning of Cardiovascular Health Information: Sources and Access Challenges

Deaf individuals have more cardiovascular risks than the general population that are believed to be related to their cardiovascular health knowledge disparities. This phenomenological study describes where 20 deaf sign language-using adolescents from Rochester, New York, many who possess many positive characteristics to support their health literacy, learn cardiovascular health information and their lived experiences accessing health information. The goal is to ultimately use this information to improve the delivery of cardiovascular health education to this population and other deaf adolescents at a higher risk for weak health literacy. Deaf bilingual researchers interviewed deaf adolescents, transcribed and coded the data, and described the findings. Five major sources of cardiovascular health information were identified including family, health education teachers, healthcare providers, printed materials, and informal sources. Despite possessing advantageous characteristics contributing to stronger health literacy, study participants described significant challenges with accessing health information from each source. They also demonstrated inconsistencies in their cardiovascular health knowledge, especially regarding heart attack, stroke, and cholesterol. These findings suggest a great need for additional public funding to research deaf adolescents' informal health-related learning, develop accessible and culturally appropriate health surveys and health education programming, improve interpreter education, and disseminate information through social media.

Barriers to calling 911 and learning and performing cardiopulmonary resuscitation for residents of primarily Latino, high-risk neighborhoods in Denver, Colorado

STUDY OBJECTIVE

Individuals in neighborhoods composed of minority and lower socioeconomic status populations are more likely to have an out-of-hospital cardiac arrest event, less likely to have bystander cardiopulmonary resuscitation (CPR) performed, and less likely to survive. Latino cardiac arrest victims are 30% less likely than whites to have bystander CPR performed. The goal of this study is to identify barriers and facilitators to calling 911, and learning and performing CPR in 5 low-income, Latino neighborhoods in Denver, CO.

METHODS

Six focus groups and 9 key informant interviews were conducted in Denver during the summer of 2012. Purposeful and snowball sampling, conducted by community liaisons, was used to recruit participants. Two reviewers analyzed the data to identify recurrent and unifying themes. A qualitative content analysis was used with a 5-stage iterative process to analyze each transcript.

RESULTS

Six key barriers to calling 911 were identified: fear of becoming involved because of distrust of law enforcement, financial, immigration status, lack of recognition of cardiac arrest event, language, and violence. Seven cultural barriers were identified that may preclude performance of bystander CPR: age, sex, immigration status, language, racism, strangers, and fear of touching someone. Participants suggested that increasing availability of tailored education in Spanish, increasing the number of bilingual 911 dispatchers, and policy-level changes, including CPR as a requirement for graduation and strengthening Good Samaritan laws, may serve as potential facilitators in increasing the provision of bystander CPR.

CONCLUSION

Distrust of law enforcement, language concerns, lack of recognition of cardiac arrest, and financial issues must be addressed when community-based CPR educational programs for Latinos are implemented.

Improving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: a randomized controlled trial

OBJECTIVE

To test the effectiveness of an individualized educational intervention on knowledge, attitudes and beliefs about acute coronary syndrome (ACS).

METHODS

This multi-site, randomized controlled trial was conducted on 1947 patients with a diagnosis of ACS. Both groups received usual in-hospital education. Participants randomized to the intervention group received a 40-min one to one individualized education session, delivered using motivational interviewing techniques. The intervention was reinforced 1 month and 6 months later. Knowledge, attitudes and beliefs were measured using the ACS Response Index. A total of 1136 patients (control, n=551; intervention, n=585) completed the questionnaire at baseline, 3 and 12 months. Data were analyzed using repeated measures analysis of variance. Ethical approval was obtained.

RESULTS

There was a significant effect of the intervention on mean knowledge (p<0.001), attitude (p=0.003) and belief (p<0.001) scores at 3 and 12 months.

CONCLUSION

Ensuring patients retain information post education has always been difficult to attain. This study demonstrated that patient education using motivational interviewing techniques and an individualized approach has the potential to alter knowledge, attitudes and beliefs about ACS among a high risk population.

PRACTICE IMPLICATIONS

This relatively short, simple and effective educational intervention could be delivered by nurses in multiple settings.

Patients' understanding of their heart attack and the impact of exposure to a media campaign on pre-hospital time

BACKGROUND

Patients with acute myocardial infarction (AMI) have a limited understanding of AMI symptoms and risk factors. This can lead to delays in the recognition of an AMI and hospital presentation. We aimed to assess patients' understanding of their AMI symptoms and risk factors and also assess the impact of exposure to a media campaign on their pre-hospital time.

METHODS

We surveyed 100 AMI patients admitted to the Canberra Hospital. We asked them about their AMI symptoms and risk factors and the impact of the National Heart Foundation (NHF) advertisements on their AMI experience.

RESULTS

Only 26% of patients recognised that they were having an AMI. In 34% of cases, an ambulance was called. There was no significant difference in the median pre-hospital time between patients who encountered the NHF advertisements and those who had not (133 minutes vs. 137 minutes, p=0.809). Only 22% of patients could identify all of their personal AMI risk factors.

CONCLUSIONS

Most AMI patients do not initially recognise their condition nor do they call for an ambulance. Exposure to the NHF advertisements had no significant influence on reducing pre-hospital time in this cohort. Most patients have a limited understanding of AMI risk factors and causes.

CHRNA5 variant predicts smoking cessation in patients with acute myocardial infarction

INTRODUCTION

While smoking is a major modifiable risk factor for secondary prevention of myocardial infarction (MI), active smoking is common among patients hospitalized with acute MI. Recent studies suggest that nicotinic receptor variants, and specifically the high-risk CHRNA5 rs16969968 A allele, are associated with cessation failure among noncardiac patients. This study investigates the association between CHRNA5 rs16969968 and smoking cessation in patients hospitalized with acute MI.

METHODS

Using data from the TRIUMPH study, we ascertained smoking status at the time of index hospitalization for acute MI and 1 year after hospitalization. After adjusting for age and sex, we used logistic regression to model the association between smoking cessation and CHRNA5 rs16969968.

RESULTS

At index admission, 752 Caucasian subjects were active smokers and 699 were former smokers. Among these ever-smokers, the A allele was associated with significantly decreased abstinence (45.0% abstinence for A allele carriers vs. 51.7% for GG homozygotes; odds ratio [OR] = 0.70, 95% confidence interval [CI] = 0.56-0.88, p = .0027). The A allele was also significantly associated with decreased abstinence at 1 year (69.1% abstinence for A allele carriers vs. 76.0% for GG homozygotes; OR = 0.70, 95% CI = 0.53-0.94, p = .0185).

CONCLUSIONS

Among patients who have smoked and who are hospitalized with acute MI, the high-risk CHRNA5 allele was associated with lower likelihood of quitting before hospitalization and significantly less abstinence 1 year after hospitalization with MI. The CHRNA5 rs16969968 genotype may therefore identify patients who would benefit from aggressive, personalized smoking cessation intervention.

The influence of ethnicity and gender on navigating an acute coronary syndrome event

BACKGROUND

Ethnicity and gender may influence acute coronary syndrome patients recognizing symptoms and making the decision to seek care.

OBJECTIVE

To examine these potential differences in European (Caucasian), Chinese and South Asian acute coronary syndrome patients.

METHODS

In-depth interviews were conducted with 20 European (Caucasian: 10 men/10 women), 18 Chinese (10 men/eight women) and 19 South Asian (10 men/nine women) participants who were purposively sampled from those participating in a large cohort study focused on acute coronary syndrome. Analysis of transcribed interviews was undertaken using constant comparative methods.

RESULTS

Participants followed the process of: having symptoms; waiting/denying; justifying; disclosing/ discovering; acquiescing; taking action. The core category was 'navigating the experience'. Certain elements of this process were in the forefront, depending on participants' ethnicity and/or gender. For example, concerns regarding language barriers and being a burden to others varied by ethnicity. Women's tendency to feel responsibility to their home and family negatively impacted the timeliness in their decisions to seek care. Men tended to disclose their symptoms to receive help, whereas women often waited for their symptoms to be discovered by others. Finally, the thinking that symptoms were 'not-urgent' or something over which they had no control and concern regarding potential costs to others were more prominent for Chinese and South Asian participants.

CONCLUSION

Ethnic- and gender-based differences suggest that education and support, regarding navigation of acute coronary syndrome and access to care, be specifically targeted to ethnic communities.

Gender, socioeconomic and ethnic/racial disparities in cardiovascular disease: a time for change

Cardiovascular disease (CVD) mortality rates have declined steadily over the past few decades but gender, socioeconomic and ethnic/racial disparities have not. These disparities impede cardiovascular health care reaching all those in need. The origins of disparities in CVD are numerous and wide-ranging, having largely evolved from inequalities in society. Similarly, disparities in CVD, interventions and outcomes will also vary depending on the minority or disadvantaged group. For this reason, strategies aimed at reducing such disparities must be stratified according to the target group, while keeping in mind that these groups are not mutually exclusive. There is a pressing need to move beyond what can be inferred from traditional cardiovascular risk factor profiling toward implementation of interventions designed to address the needs of these populations that will eventuate in a reduction of disparities in morbidity and mortality from CVD. This will require targeted and sustainable actions. Only by ensuring timely and equitable access to care for all through increased awareness and active participation can we start to close the gap and deliver appropriate, acceptable and just care to all, regardless of gender, socioeconomic status or ethnicity/race.

What is killing? People's knowledge about coronary heart disease, attitude towards prevention and main risk reduction barriers in Ismailia, Egypt (descriptive cross-sectional study)

INTRODUCTION

Cardiovascular diseases are a public health concern everywhere, especially ischemic or coronary heart diseases (CHD) which are on top of causes list of mortality and morbidity in both genders globally. From which nearly 80% can be because of modifiable risks. In Egypt, there is a lack of studies on the knowledge of people about coronary heart diseases and its modifiable risks. So, this research reported here we designed to measure the dimensions of peoples knowledge about CHD and their attitude towards prevention, and to identify the main risk reduction barriers.

METHODS

By using comprehensive cross-sectional, descriptive research design, all adult individuals attending the family health clinic at Suez Canal University Hospital were eligible for inclusion with total number 125 participants. An interview questionnaire designed and used to collect data.

RESULTS

The study revealed that (10.4%) of participants had a history of CHD, and (7.2%) had a family history of CHD. 79.2% Had a satisfactory total knowledge about CHD, and (94.4%) had a positive total attitude towards prevention. Risk reduction barriers as a medical setting barriers were (24%), patient related barriers were (22.4%). Community-societal barriers were almost the same as knowledge barriers which were around (16%). At last the systemic-organizational barriers were (9.6%).

CONCLUSION

The findings settled that, total knowledge about CHD was satisfactory but lower than the level total of attitude. More effort the health system needs to improve the settings and engage patients in their plans and breaking related barriers, with development of health education programs based on needs assessment. Further studies we recommend to explore the reasons and follow up the changes.

Impact of targeted health promotion on cardiovascular knowledge among American Indians and Alaska Natives

The National Heart, Lung, and Blood Institute developed the Honoring the Gift of Heart Health (HGHH) curriculum to promote cardiovascular knowledge and heart-healthy lifestyles among American Indians and Alaska Natives (AI/ANs). Using data from a small randomized trial designed to reduce diabetes and cardiovascular disease (CVD) risk among overweight/obese AI/ANs, we evaluated the impact of an adapted HGHH curriculum on cardiovascular knowledge. We also assessed whether the curriculum was effective across levels of health literacy (defined as the 'capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions'). We examined change in knowledge from baseline to 3 months for two groups: HGHH (N = 89) and control (N = 50). Compared with controls, HGHH participants showed significant improvement in heart attack knowledge and marginally significant improvement in stroke and general CVD knowledge. HGHH participants attending ≥1 class showed significantly greater improvement than controls on all three measures. Although HGHH participants with inadequate health literacy had worse heart attack and stroke knowledge at baseline and 3 months than did participants with adequate skills, the degree of improvement in knowledge did not differ by health literacy level. HGHH appears to improve cardiovascular knowledge among AI/ANs across health literacy levels.

Factors Affecting Decision Making in Hispanics Experiencing Myocardial Infarction

It was estimated that 785,000 new myocardial infarctions (MIs), 470,000 recurrent MIs, and 195,000 silent MIs will occur during 2010 in the United States. Cardiovascular disease, including heart disease and stroke, is the cause of death for 27% of Hispanic males and 31.5% of Hispanic females. There has been an increasing discrepancy between Hispanic knowledge in recognition of MI symptoms compared with non-Hispanic Whites. Only 5.6 % to 27.4 % of Hispanics know all MI symptoms and the need to immediately activate emergency medical services, compared with 11.9% to 45.8% of non-Hispanic Whites. The health belief model is used to explore the factors affecting decision making in Hispanics experiencing MI. Modifying factors explored include acculturation, language spoken, education, socioeconomic status, and access to health care. The results include recommendations for future research and clinical practice to assist in planning targeted interventions in Hispanic populations nationwide.

Public health options for improving cardiovascular health among older Americans

Life expectancy at birth has increased from 74 years in 1980 to 78 years in 2006. Older adults (aged 65 years and older) are living longer with cardiovascular conditions, which are leading causes of death and disability and thus an important public health concern. We describe several major issues, including the impact of comorbidities, the role of cognitive health, prevention and intervention approaches, and opportunities for collaboration to strengthen the public health system. Prevention can be effective at any age, including for older adults. Public health models focusing on policy, systems, and environmental change approaches have the goal of providing social and physical environments and promoting healthy choices.

Knowledge of heart attack and stroke symptomology: a cross-sectional comparison of rural and non-rural US adults

Background

Understanding the signs and symptoms of heart attacks and strokes are important not only in saving lives, but also in preserving quality of life. Findings from recent research have yielded that the prevalence of cardiovascular disease risk factors are higher in rural populations, suggesting that adults living in rural locales may be at higher risk for heart attack and/or stroke. Knowledge of heart attack and stroke symptomology as well as calling 911 for a suspected heart attack or stroke are essential first steps in seeking care. This study sought to examine the knowledge of heart attack and stroke symptoms among rural adults in comparison to non-rural adults living in the U.S.

Methods

Using multivariate techniques, a cross-sectional analysis of an amalgamated multi-year Behavioral Risk Factor Surveillance Survey (BRFSS) database was performed. The dependent variable for this analysis was low heart attack and stroke knowledge score. The covariates for the analysis were: age, sex, race/ethnicity, annual household income, attained education, health insurance status, having a health care provider (HCP), timing of last routine medical check-up, medical care deferment because of cost, self-defined health status and geographic locale.

Results

The weighted n for this study overall was 103,262,115 U.S. adults > =18 years of age. Approximately 22.0% of these respondents were U.S. adults living in rural locales. Logistic regression analysis revealed that those U.S. adults who had low composite heart attack and stroke knowledge scores were more likely to be rural (OR = 1.218 95%CI 1.216-1.219) rather than non-rural residents. Furthermore, those with low scores were more likely to be: male (OR = 1.353 95%CI 1.352-1.354), >65 years of age (OR = 1.369 95%CI 1.368-1.371), African American (OR = 1.892 95%CI 1.889-1.894), not educated beyond high school (OR = 1.400 955CI 1.399-1.402), uninsured (OR = 1.308 95%CI 1.3-6-1.310), without a HCP (OR = 1.216 95%CI 1.215-1.218), and living in a household with an annual income of < $50,000 (OR = 1.429 95%CI 1.428-1.431).

Conclusions

Analysis identified clear disparities between the knowledge levels U.S. adults have regarding heart attack and stroke symptoms. These disparities should guide educational endeavors focusing on improving knowledge of heart attack and stroke symptoms.

Awareness of heart attack symptoms among US adults in 2007, and changes in awareness from 2001 to 2007

OBJECTIVE

Timely access to emergency care, prompt receipt of advanced treatment and survival from heart attack is dependent on both the early recognition of heart attack symptoms, by both victims and bystanders, and by immediately calling the emergency services. The objective of this study is to measure the awareness of heart attack symptoms and the emergency response among US adults.

METHOD

We analyzed data from the Behavioral Risk Factor Surveillance System's module on heart attack and stroke, which was conducted in 17 states/territories in 2001 and 12 states/territories in 2007. The module included five questions related to heart attack symptoms, one decoy question and one question regarding the first action to take if someone is having a heart attack. Age-adjusted prevalence of awareness was estimated, and odds ratios were calculated. Differences between 2001 and 2007 were assessed for five states that used the module in both years.

RESULTS

In 2007, among 76,864 adults, awareness of individual heart attack symptoms ranged from 49% (pain in jaw, neck or back) to 92% (chest pain). Although 97% of adults recognized at least one symptom, only 10.7% recognized all five symptoms, knew that 'sudden trouble seeing in one or both eyes' was not a symptom of heart attack and recognized the need to call the emergency services. This estimate varied significantly by age, sex, race/ethnicity and level of education. The estimate was significantly higher for women (12.2%) than men (7.7%), White (11.6%) than Black (5.7%) or Hispanic people (4.5%), those with a higher level of education (13.5%) than lower educational level (4.5%) and for those with coronary heart disease (16.2%) than without the disease (9.5%). Comparison of awareness between 2001 (the referent) and 2007, in five states, revealed that awareness of all symptoms and calling the emergency services, were 9.7 and 10.3% for 2001 and 2007, respectively (p < 0.01). Compared to 2001, the odds ratio of awareness in 2007 was 1.08 (95% CI: 0.99-1.19) after controlling for socioeconomic and clinical characteristics.

CONCLUSION

Awareness of all heart attack symptoms among adults in 12 states was low and little improvement was observed between 2001 and 2007. Accordingly, both clinicians and public health officials should seek ways in order to increase public awareness of the symptoms of heart attack. Special efforts should be focused on men, Black and Hispanic people and those with only modest levels of education.

Knowledge of stroke and heart attack symptoms and risk factors among rural elderly people: a questionnaire survey

Background and Objectives

To determine the level of knowledge of stroke and heart attack (HA) symptoms and risk factors of cardiovascular disease (CVD) in rural elderly people who are at risk for CVD.

Subjects and Methods

A total of 444 adults over the age of 60 living in a rural province of Korea with at least one CVD risk factor participated in this survey.

Results

A total of 72.5% of the participants had hypertension and 28.4% had diabetes, whereas approximately 40% exhibited over two CVD risk factors. The mean knowledge scores for HA symptoms (4.3/9) were lower than scores for stroke symptoms (5.8/9), and the mean knowledge score for risk factors was 7.3/11. Stepwise multiple regression analyses showed that old age, low level of education, and low income level were the determining factors for low knowledge levels of stroke and HA symptoms as well as CVD risk factors. A low perceived risk of stroke or HAs also predicted a low knowledge of CVD risk factors.

Conclusion

Community-wide public campaigns are needed, which are designed to help elderly people in rural areas with low education levels and socioeconomic status at risk for CVD to improve the awareness of stroke and HA.

Cardiovascular knowledge among urban American Indians and Alaska Natives: first steps in addressing cardiovascular health

BACKGROUND

Cardiovascular disease (CVD) is common among American Indians/Alaska Natives (AI/ANs). Given limited access to health care, urban AI/ANs may be at particular risk. Lack of available data, however, limits our understanding of cardiovascular health in this population.

OBJECTIVES

We conducted a survey to characterize CVD-related knowledge, behavior, and risk of urban AI/ANs. Results related to knowledge are reported.

METHODS

In collaboration with the Indian clinics in two urban communities, we surveyed 298 AI/ANs.

RESULTS

Respondents recognized approximately half of the symptoms of heart attack and stroke, and were significantly less likely to recognize each symptom than reported in national studies using the same items. General CVD knowledge (e.g., risks of high blood pressure) was stronger, although areas for improvement were noted.

CONCLUSIONS

Urban AI/ANs would benefit from efforts to enhance CVD knowledge. These preliminary data are providing the foundation for community-based efforts to address CVD risk among urban AI/ANs.

Gender differences in time to presentation for myocardial infarction before and after a national women's cardiovascular awareness campaign: a temporal analysis from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation (CRUSADE) and the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network-Get with the Guidelines (NCDR ACTION Registry-GWTG)

BACKGROUND

In 2001-2002, the American Heart Association and National Heart, Lung, and Blood Institute initiated national campaigns with the aim of increasing women's awareness of their risk of heart disease, with particular focus on women aged 40 to 60 years. Our aim is to determine if these women's awareness campaigns were associated with a reduction in the time to hospital presentation for myocardial infarction in women.

METHODS

The study population comprised patients who presented with a non-ST-segment elevation myocardial infarction in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines Registry and the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network-Get with the Guidelines registry. Analysis was done based on the introduction of the educational intervention: preintervention 2002-2003, intermediate 2004-2005, and post 2006-2007.

RESULTS

Of 125,161 patients, 50,162 (40.1%) are women. The median time from symptom onset to presentation was significantly longer in women than men: 3 hours (interquartile range 1.4-7.6) versus 2.8 hours (interquartile range 1.3-7.2, P < .0001), a difference that remained significant after adjusting for clinical characteristics. There was no measurable reduction in the time from symptom onset to presentation over the period of the awareness campaigns: post- versus preintervention period (-0.18%, 95% CI -3.02% to 2.74%). After adjustment for covariates, women aged 40 to 60 years had a 3.46% longer time to presentation than men (95% CI 1.06-5.92, P = .005).

CONCLUSIONS

There was no reduction in time from symptom onset to hospital presentation for myocardial infarction patients since national awareness campaigns in women were initiated, and a significant gender gap remains.

Ethnic variation in acute myocardial infarction presentation and access to care

Given the growing ethnic diversity in Canada, it is essential to recognize potential ethnic variability in acute myocardial infarction (AMI) symptoms to increase timely and effective treatment. We thus examined ethnic variation in symptom presentation and access to care of patients presenting to the emergency department (ED) with AMI. A random sample of 406 health records of Caucasian, Chinese, South Asian, Southeast Asian, and First Nations patients discharged from hospitals in the Calgary Health Region (Alberta, Canada) was audited. Measured variables were compared across ethnic groups and associations with classic AMI symptom profile and timely presentation to a hospital were examined. Chinese, South Asian, and Southeast Asian patients were 64% to 69% less likely than Caucasian patients to have a classic symptom profile reported and were less likely to speak English than their Caucasian and First Nations counterparts (p <0.001). Thirty-nine percent of patients who had a reported distinct time of symptom onset waited >12 hours to present to the ED; even in patients who presented with a classic symptom profile, South Asians were 70% less likely than Caucasians to report to the ED within 3 hours of symptom onset. Caucasians were significantly more likely to undergo angiography within 3 hours of presentation to the ED (42%, p = 0.001). In conclusion, explanatory variables associated with variability in symptom presentation and access to care associated with ethnicity require further exploration to ultimately develop effective strategies aimed at increasing timely presentation and care access.

Lay public's knowledge and decisions in response to symptoms of acute myocardial infarction

Despite public health initiatives targeting rapid action in response to symptoms of myocardial infarction (MI), people continue to delay in going to a hospital when experiencing these symptoms due to lack of recognition as cardiac-related. The objective of this research was to characterize lay individuals' knowledge of symptoms of acute myocardial infarction (AMI) and associated decision processes for timely action. Thirty participants were interviewed about their knowledge of AMI, then presented with unrelated, unfamiliar and familiar scenarios of AMI symptoms and instructed to "think aloud" as they made decisions in response to the scenarios in order to capture the decision process directly. Data were analyzed using qualitative and quantitative methods to identify the semantic relationships between knowledge and decisions. Results showed that most participants (80%) identified three symptoms or less (e.g., chest pain: 93%; dyspnea: 53%). All participants identified urgent actions (calling 911, going to ED) as the appropriate response to AMI symptoms. Urgent action decisions increased with familiarity of symptoms (57% for unrelated symptoms to 83% for most familiar symptoms), and was highest for the cardiac group. Lay knowledge of AMI is necessary, but not sufficient for people to develop required heuristics for timely action. This ineffective decision increases as a function of ambiguous and unfamiliar situations. Health education interventions should focus on teaching clusters of problems with varying levels of familiarity and complexity to increase flexibility in making decisions.

Cardiovascular risk factors and knowledge of symptoms among Vietnamese Americans

BACKGROUND

There are few population-based studies of cardiovascular risk factors, knowledge, and related behaviors among Vietnamese Americans.

OBJECTIVE

To describe cardiovascular risk factors, knowledge, and related behaviors among Vietnamese Americans and compare the results to non-Hispanic whites.

DESIGN

Comparison of data from two population-based, cross-sectional telephone surveys.

PARTICIPANTS

Vietnamese Americans in Santa Clara County, California, and non-Hispanic whites in California, aged 18 and older.

MEASUREMENTS

Survey measures included sociodemographics, diagnoses, body mass index, fruit and vegetable intake, exercise, and tobacco use. Knowledge of symptoms of heart attack and stroke was collected for Vietnamese Americans.

MAIN RESULTS

Compared to non-Hispanic whites (n = 19,324), Vietnamese Americans (n = 4,254) reported lower prevalences of obesity, diabetes mellitus, coronary heart disease, and hypertension, and similar prevalences of stroke and hypercholesterolemia. Fewer Vietnamese Americans consumed fruits and vegetables five or more times daily (27.8% vs 16.3%, p < 0.05), and more reported no moderate or vigorous physical activity (12.1% vs 40.1%, p < 0.05). More Vietnamese men than non-Hispanic White men were current smokers (29.8% vs 19.0%, p < 0.05). Vietnamese Americans who spoke Vietnamese were more likely than those who spoke English to eat fruits and vegetables less frequently, engage in no moderate or vigorous physical activity, and, among men, be current smokers. Only 59% of Vietnamese Americans knew that chest pain was a symptom of heart attack.

CONCLUSIONS

There are significant disparities in risk factors and knowledge of symptoms of cardiovascular diseases among Vietnamese Americans. Culturally appropriate studies and interventions are needed to understand and to reduce these disparities.

Gender differences in patient perceptions of involvement in myocardial infarction care

BACKGROUND

Gender differences in the clinical presentation, treatment and outcomes of myocardial infarction (MI) have been demonstrated. However, few studies have examined gender differences in patients' perceptions of involvement in MI care, and whether differing levels of involvement might be associated with gender differences in treatment and outcome.

AIM

To examine possible gender differences in MI patients' perceptions of their involvement during hospitalization.

METHODS

Questionnaire study conducted in 2005-2006 among MI patients under the age of 75 at eleven hospitals. Patient ratings of their involvement during hospitalization were analyzed for age-stratified gender differences.

RESULTS

Younger (<70 years of age) female MI patients placed significantly more value on shared decision-making than younger (<70) men. More than one third of patients would have liked to be more involved in their care during hospitalization and discharge planning, with women significantly more dissatisfied than men. Significantly fewer younger female patients discussed secondary preventive lifestyle changes with cardiology staff prior to hospital discharge.

CONCLUSION

Significant age-specific gender differences exist in MI patient ratings of, and satisfaction with, involvement during hospitalization. Further study is needed regarding the possible role of involvement in the recognized gender differences in the treatment and outcomes of MI.

Disparities in knowledge of heart attack and stroke symptoms among adult men: an analysis of behavioral risk factor surveillance survey data

CONTEXT

The staggering burden of myocardial infarction and stroke in men and for men of African-American descent in particular provided the impetus for this study. Morbidity and mortality from these vascular disorders can be reduced by early treatment, which requires correct prehospital identification of symptoms.

OBJECTIVE

The purpose of this study was to assess current knowledge of myocardial infarction and stroke symptoms and to examine if there were disparities in knowledge of these among U.S. males.

DESIGN

This is a cross-sectional study analyzing public use 2003-2005 Behavioral Risk Factor Surveillance Survey data. Univariate, bivariate and multivariate techniques were used.

SETTING

Random-digit-dial telephone survey focused on health risk factors and behaviors. Data collection was done under the direction of the Centers for Disease Control and Prevention.

PATIENTS OR OTHER PARTICIPANTS

Data collections targeted noninstitutionalized U.S. adults 18-90 years of age. This study focused on the adult male population.

MAIN OUTCOME MEASURES

From the 13 heart attack and stroke symptom knowledge questions asked on the survey, a heart attack and stroke knowledge score was computed for each respondent.

RESULTS

Multivariate analysis revealed that both Caucasian and African-American men earning low scores on the knowledge questions were more likely to: have less than a high-school education, have deferred medical care in the past 12 months because of cost and not have health insurance in the past 12 months. African-American men were also more likely to live in households with annual incomes < $35,000 and were more likely to not have a primary care provider; this was not true for Caucasian men.

CONCLUSIONS

There is a disparity in myocardial infarction and stroke symptom knowledge along racial and socioeconomic lines. African-American males, poorer individuals and those with lower levels of education had significantly lower scores. Since these subgroups are also among those at higher risk for stroke and myocardial infarction, targeting measures to enhance knowledge in these groups might yield more benefit than programs aimed at the general male populace.

So much to do, so little time: care for the socially disadvantaged and the 15-minute visit

There is so much to do in primary care, and so little time to do it. During 15-minute visits, physicians are expected to form partnerships with patients and their families, address complex acute and chronic biomedical and psychosocial problems, provide preventive care, coordinate care with specialists, and ensure informed decision making that respects patients' needs and preferences. This is a challenging task during straightforward visits, and it is nearly impossible when caring for socially disadvantaged patients with complex biomedical and psychosocial problems and multiple barriers to care. Consider the following scenario.

Disparities in adult African American women's knowledge of heart attack and stroke symptomatology: an analysis of 2003-2005 Behavioral Risk Factor Surveillance Survey data

BACKGROUND

Heart disease and stroke are the first and third leading causes of death of American women, respectively. African American women experience a disproportionate burden of these diseases compared with Caucasian women and are also more likely to delay seeking treatment for acute symptoms. As knowledge is a first step in seeking care, this study examined the knowledge of heart attack and stroke symptoms among African American women.

METHODS

This was a cross-sectional study analyzing 2003-2005 Behavioral Risk Factor Surveillance Survey (BRFSS) data. A composite heart attack and stroke knowledge score was computed for each respondent from the 13 heart attack and stroke symptom knowledge questions. Multivariate logistic regression was performed using low scores on the heart attack and stroke knowledge questions as the dependent variable.

RESULTS

Twenty percent of the respondents were low scorers, and 23.8% were high scorers. Logistic regression analysis showed that adult African American women who earned low scores on the composite heart attack and stroke knowledge questions (range 0-8 points) were more likely to be aged 18-34 (OR = 1.36, CI 1.35, 1.37), be uninsured (OR = 1.32, CI 1.31, 1.33), have an annual household income <$35,000 (OR = 1.46, CI 1.45, 1.47), and have a primary healthcare provider (OR = 1.22, CI 1.20, 1.23).

CONCLUSIONS

The findings indicated that knowledge of heart attack and stroke symptoms varied significantly among African American women, depending on socioeconomic variables. Targeting interventions to African American women, particularly those in lower socioeconomic groups, may increase knowledge of heart attack and stroke symptoms, subsequently improving preventive action taken in response to these conditions.