Heart attack prone not aware of symptoms and risk


Heart attack prone not aware of symptoms and risk

Of patients with a history of heart disease, almost half have poor knowledge about the symptoms of heart attacks, and do not identify themselves as having an elevated cardiovascular risk, according to an article released on May 26, 2008 in the Archives of Internal Medicine, one of the JAMA/Archives journals.

Heart disease indicates that an individual has five to seven times the risk of having a heart attack or dying as the general population. Following heart attack, survival rates improve if treatment begins within one hour following the event. However, most hospital admittance of heart attack victims occurs between two and a half and three hours after the start of symptoms. According to the authors, "Barriers to seeking appropriate care quickly are both cognitive and emotional." It follows that if patients are uninformed about the symptoms of heart attack and other syndromes related to heart disease, they will not seek treatment. Namely, if they do not see themselves as at risk for a heart attack, they will first attribute other explanations for these symptoms, which can specifically include nausea, or pain in the jaw, chest, or left arm.

To explore this factor in coronary disease treatment, Kathleen Dracup, D.N.Sc., of the University of California, San Francisco, School of Nursing, and colleagues canvased 3,522 patients, with an average age of 67 years, with histories of heart attack or invasive procedures to widen arteries. They were asked to identify the possible symptoms of heart attack and to respond to several true-false questions related to heart disease. Finally, they were asked whether their risk of heart attack in the next five years was greater or less than others'.

When scored on cardiac knowledge, the average score was 71%. On the test 70% was defined as a "low knowledge level"-- a distinction achieved by 44% of the patients. A few groups of patients had a tendency to score higher on the test: women, individuals who had participated in cardiac rehabilitation, subjects with higher levels of education, younger people, and patients who receieved their care from a cardiologist rather than a family practitioner.

The authors also found that, in a group of high risk individuals, a disproportionate number were unaware of their relatively dangerous situations. "In this group of patients, who were all at high risk for a future acute myocardial infarction, 43 percent inappropriately assessed their risk as less than or the same as other people their age," the authors say. "More men than women perceived themselves as being at low risk (47 percent vs. 36 percent, respectively)."

This difference is attributed, in the article, to a lack of time spent on education for these patients. "Patients require continued reinforcement about the nature of cardiac symptoms, the benefits of early treatment and their risk status," they write. "Our findings suggest that men, elderly individuals, those with low levels of education and those who have not attended a cardiac rehabilitation program are more likely to require special efforts during medical office visits to review symptoms of acute myocardial infarction and to learn the appropriate actions to take in the face of new symptoms of acute coronary syndromes."

Acute Coronary Syndrome: What Do Patients Know?

Kathleen Dracup, DNSc; Sharon McKinley, RN, PhD; Lynn V. Doering, RN, DNSc; Barbara Riegel, RN, DNSc; Hendrika Meischke, PhD; Debra K. Moser, RN, DNSc; Michele Pelter, RN, PhD; Beverly Carlson, RN, MS; Leanne Aitken, RN, PhD; Andrea Marshall, RN, MS; Rebecca Cross, RN, PhD; Steven M. Paul, PhD

Arch Intern Med. 2008;168[10]:1049-1054.

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Section Issues On Medicine: Cardiology