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patients with Heart Disease have poor
knowledge of Heart Attack symptoms
Newswise — Nearly half of patients with a
history of heart disease have poor knowledge
about the symptoms of a heart attack and do
not perceive themselves to have an elevated
cardiovascular risk, according to a report
in the May 26 issue of Archives of Internal
Medicine, one of the JAMA/Archives journals.
Individuals with heart disease have five to
seven times the risk of having a heart
attack or dying as the general population,
according to background information in the
Survival rates improve following heart
attack if treatment begins within one hour.
However, most patients are admitted to the
hospital 2.5 to three hours after symptoms
begin. “Barriers to seeking appropriate care
quickly are both cognitive and emotional,”
the authors write.
If patients do not know the symptoms of
acute myocardial infarction (heart attack)
and other acute coronary syndromes—including
nausea and pain in the jaw, chest or left
arm—they will not seek treatment for them.
If they do not perceive themselves to be at
risk for heart attack, they will look for
another explanation when they experience
Kathleen Dracup, D.N.Sc., of the University
of California, San Francisco, School of
Nursing, and colleagues surveyed 3,522
patients (average age 67) who had a history
of heart attack or an invasive procedure for
treating narrowed arteries.
The patients were asked to identify possible
symptoms of heart attack and responded to
true-false questions about heart disease.
Participants also were asked whether they
were more or less likely than other
individuals their age to have a heart attack
in the next five years.
The average cardiac knowledge score was 71
percent. Despite their history of heart
disease, 44 percent of the patients had low
knowledge levels, as documented by scores of
less than 70 percent.
Women, individuals who had participated in
cardiac rehabilitation, those with higher
education levels, younger individuals and
those who received care from a cardiologist
as opposed to a family practitioner or
internist tended to score higher.
“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
“More men than women perceived themselves as
being at low risk (47 percent vs. 36
Changes in the health care delivery system
have led to less hospital time for heart
disease patients, reducing the amount of
time available for education about heart
disease symptoms, the authors note.
“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.”
Editor’s Note: Funding was provided by the
National Institute of Nursing Research,
National Institutes of Health. Please see
the article for additional information,
including other authors, author
contributions and affiliations, financial
disclosures, funding and support, etc.
Editorial: Findings Encourage Support of
The researchers “found two modifiable
factors identified with increased knowledge
about coronary artery disease: participation
in cardiac rehabilitation and receiving care
by a cardiologist,” writes Robert A.
Phillips, M.D., Ph.D., of the UMass Memorial
Medical Center, Worcester, in an
“These findings should help to fuel the
recent focus on the barriers, benefits and
methods to improve participation in cardiac
rehabilitation by coronary artery disease
patients,” he continues.
“Health care theory suggests that the
highest level of care is provided when
payments and best health care practices are
this end, payers such as Centers for
Medicare and Medicaid Services and private
insurers should develop a tiered approach to
payment for cardiac care, providing higher
reimbursements for those hospitals that
offer cardiac rehabilitation and higher
reimbursement to physicians and hospitals
who consistently refer eligible patients for
cardiac rehabilitation,” Dr. Phillips