Many Senior Citizens with Heart Disease Have Poor
Knowledge of Heart Attack Symptoms
Despite 5 to 7 times more risk they don’t get it –
women do better than men
May 27, 2008 – A new study has produced the
stunning results that show nearly half of the people with a history of
heart disease know very little about the symptoms of a heart attack and
do not even consider themselves to have an elevated cardiovascular risk.
The effectiveness of therapy for an acute coronary
syndrome (ACS) is dependent on a patients' quick decision to seek
treatment. These researchers surveyed the level of knowledge about heart
disease and self-perceived risk for a future acute myocardial infarction
(AMI) in patients with documented ischemic heart disease.
Thiazolidinediones medications (including rosiglitazone
(Avandia)
produced a significantly increased risk of heart attack, congestive
heart failure and death
The study is reported 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 article.
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 these symptoms.
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.
About Heart
Diseases
Also called: Cardiac disease
If you're
like most people, you think that heart disease is a problem for
other folks. But heart disease is the number one killer in the
U.S. It is also a major cause of disability.
There are
many different forms of heart disease.
The most
common cause of heart disease is narrowing or blockage of the
coronary arteries, the blood vessels that supply blood to the
heart itself. This is called
coronary artery disease and happens slowly over time. It's
the major reason people have
heart attacks.
Other kinds
of heart problems may happen to the
valves in the heart, or the heart may not pump well and
cause
heart failure. Some people are
born with heart disease.
You can help
reduce your risk of heart disease by taking steps to control
factors that put you at greater risk:
● Control your
blood pressure
● Lower your
cholesterol
● Don't smoke
● Get enough exercise
Some heart
attacks are sudden and intense — the "movie heart attack," where
no one doubts what's happening. But most heart attacks start
slowly, with mild pain or discomfort. Often people affected
aren't sure what's wrong and wait too long before getting help.
Here are signs that can mean a heart attack is happening:
● Chest
discomfort. Most heart attacks involve discomfort in the center
of the chest that lasts more than a few minutes, or that goes
away and comes back. It can feel like uncomfortable pressure,
squeezing, fullness or pain.
●
Discomfort in other areas of the upper body. Symptoms can
include pain or discomfort in one or both arms, the back, neck,
jaw or stomach.
●
Shortness of breath with or without chest discomfort.
● Other
signs may include breaking out in a cold sweat, nausea or
lightheadedness
As with men,
women's most common heart attack symptom is chest pain or
discomfort. But women are somewhat more likely than men to
experience some of the other common symptoms, particularly
shortness of breath, nausea/vomiting, and back or jaw pain.
Learn the
signs, but remember this: Even if you're not sure it's a heart
attack, have it checked out (tell a doctor about your symptoms).
Minutes matter!
Fast action can save lives — maybe your own.
Don’t wait more than five minutes to call 9-1-1.
>> More information at American
Heart Association,
click here
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 write. “More men than women perceived
themselves as being at low risk (47 percent vs. 36 percent,
respectively).”
Sex is an important predictor of clinical outcome
in ACS, with women having higher mortality following AMI and longer
prehospital delay to treatment of an ACS than men. Given that one of the
most powerful predictors of knowledge in this study was sex, with women
significantly more likely to have a score of at least 70% on the
Knowledge Scale than men.
“We further examined differences between men and
women in cardiac knowledge. Overall knowledge scores were higher for
women than men (73% vs 70%). Women more accurately identified
less-typical symptoms of AMI than men (back pain, jaw pain, heartburn,
nausea, and neck pain),” the author’s report.
Additionally, fewer men than women knew that heart
disease was the most common cause of death in women.
And, more men than women stated their preference
for someone to drive them to the hospital if they experienced AMI
symptoms rather than go by ambulance
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.
Editorial: Findings encourage support of cardiac
rehabilitation
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 accompanying editorial.
“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
aligned. To 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 concludes.
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