CARDEONEWS

by Jorge Chavez, M.D. F.A.C.C.

Heart Patients Know Little About Cardiac Disease, Study Finds

By Chantal Britt

May 26 (Bloomberg) -- Almost half of patients with coronary disease don't know what the symptoms of heart attacks are and don't see themselves as being at heightened risk, according to a study in the Archives of Internal Medicine.

Forty-six percent of people studied had scores of 70 percent or less on a scale of knowledge about acute coronary syndrome, or ACS, and inappropriately assessed their risk as less than or the same as other people their age, a survey of 3,522 patients in the U.S., Australia and New Zealand found.

People already suffering from heart disease have a five to sevenfold greater risk of having or dying from a heart attack than the general population. Survival rates improve by up to 50 percent if the restoration of blood flow to organs or tissue is achieved within one hour. Delaying treatment by 30 minutes cuts the mean life expectancy by a year.

``Although knowledge about heart disease and its symptoms is not sufficient to reduce delay in treatment, it's necessary for patients to have this information so they can quickly identify symptoms of acute coronary syndrome and take prompt action to seek care,'' scientists led by Kathleen Dracup at the University of California in San Francisco wrote in the study.

An inability to identify symptoms such as nausea, jaw pain and fainting, as well as more common signs such as chest and left arm pain, boost the median time from symptom onset to hospital admission, which is now 2.5 to 3 hours.

Knowledge Scale: Patients were asked to identify possible heart attack symptoms from a list of 15 correct and 6 incorrect symptoms. They were also asked to respond to five statements about heart disease with true or false responses. The mean score was 71 percent.

Even following diagnosis of ACS and numerous interactions with physicians and other health-care professionals, knowledge about ACS symptoms and treatment on the part of patients with cardiac disease remains poor,'' Dracup said.

Higher scores were linked to female sex, younger age, higher education, participation in cardiac rehabilitation and care by a cardiologist rather than an internist or general practitioner, the researchers found.

Most patients in the study identified themselves as being at a higher risk for a future heart attack compared with an individual the same age who didn't have heart disease, though patients who had had bypass surgery were an exception. They felt significantly less vulnerable compared with people the same age.

More men than women perceived themselves as being at low risk. Still, men were significantly more confident they would recognize heart attack signs or symptoms in themselves or others compared with women, although they knew less about symptoms of cardiac arrest than women.

``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,'' Dracup said.
To contact the reporter on this story: Chantal Britt at cbritt@bloomberg.net.

  

Mon May 26, 2008 8:33pm EDT

CHICAGO (Reuters) - Many people with heart disease do not know the symptoms of a heart attack, even though their risk of suffering one is five to seven times higher than those with no such history, researchers reported on Monday.

Symptoms can include nausea and pain in the jaw, chest or left arm. But the research team said shorter hospital stays and a move to outpatient treatment have decreased the amount of patient education on the subject.

Kathleen Dracup and colleagues at the University of California, San Francisco, School of Nursing said they looked at 3,522 patients in the United States, Australia and New Zealand who had previously suffered a heart attack or had undergone a procedure, such as angioplasty, for heart disease.

They found that 44 percent of them scored poorly on a true-false test measuring how savvy they were about symptoms.
Women in general along with patients who had taken part in cardiac rehabilitation, those with higher education, younger people and those who were treated by a heart specialist rather than a family doctor tended to have the best scores on the test, the report said.

"In decades past such patients were frequently hospitalized and would receive education and counseling from physicians and nurses during their hospital stay," they said in the report published in the Archives of Internal Medicine.
"Unfortunately structural changes in health care delivery have led to decreased lengths of hospital stay and increased use of outpatient facilities ... which in turn have had a dramatic effect on the time available for the education of patients," they added.

Those who suffer a heart attack have a better chance of surviving if treatment begins within one hour, the study said, but most patients are admitted to the hospital 2-1/2 hours to three hours after symptoms begin.
The authors said numerous studies have found that patients who have already suffered an earlier heart attack do not seek help any faster than those who had no such health history. Given the lack of knowledge about the range of symptoms as measured in the study, they said, that is not surprising.