Clinical Medicine Insights: Cardiology

Background: Temporal delays in myocardial infarction (MI) treatment have been addressed through patient and physician education, innovations in prehospital fibrinolysis, and improvements to emergency medical services, yet the most significant contributor to delayed treatment is the patient’s ability to recognize and respond to symptoms.

Purpose: To determine whether public health education campaigns have achieved their desired reach by ensuring that all segments of the population recognize the symptoms of MI (“heart attack”).

Methods: 976 men and women, 40+ years of age, randomly selected from Metro Vancouver, Canada completed a telephone survey in English, Punjabi, Mandarin, or Cantonese. Respondents’ knowledge of MI symptoms was assessed; 10 “correct symptoms” were considered to be: chest pain/pressure/tightness/discomfort, arm pain, shortness of breath, nausea/indigestion, sweating/clamminess, shoulder/back pain, dizziness/faintness/light headedness, jaw pain, weakness, and uneasiness/panic/anxiety.

Results: 3.2% of the sample could not identify any correct symptoms and 53.3% were able to describe 3+ symptoms. Significant associations were found between the number of correct symptoms and gender, ethnicity, education, exposure to health professional counseling, and worry about having a heart attack. The least number of correct symptoms were reported by: men (incidence rate ratio (IRR) = 0.87; 95% confidence interval (95% CI): 0.81−0.95), Chinese-Canadian participants (IRR = 0.73; 95% CI: 0.65−0.83; relative to European-Canadian born participants), those with less than high school education (IRR = 0.78; 95% CI: 0.66−0.92; relative to those with more than high school), those with no health professional counseling (IRR = 0.92; 95% CI: 0.84−1.00), and those who did not worry “at all” about having a heart attack (IRR = 0.89; 95% CI: 0.80−0.98; relative to those who worried sometimes/often/almost all the time).

Conclusions: The participants were not well informed about the symptoms of heart attack. It will be challenging to educate the public sufficiently to reduce the time between the onset of symptoms and initiation of treatment for MI.