To reduce mortality and morbidity associated with acute coronary syndrome (ACS), individuals who experience ACS symptoms should seek treatment promptly. However, for this to be possible, they must adopt appropriate attitudes and beliefs about ACS symptoms and have the prerequisite knowledge to respond to those symptoms.
Aim:
This paper details the results of a cross-sectional Irish study that measured knowledge, attitudes, and beliefs about ACS in patients diagnosed with ACS.
Methods:
A total of 1947 patients were enrolled in the study. Recruitment took place across five academic teaching hospitals in Dublin, Ireland. Knowledge, attitudes, and beliefs about ACS were measured using the ACS Response Index questionnaire.
Results:
Almost half the patients (n=49.5%) demonstrated high knowledge levels (i.e. >70% of correct answers) about ACS symptoms. The majority recognized chest pain/pressure (98.9%) and left arm pain (90.2%) as symptoms. Many failed to associate jaw pain, heartburn and/or indigestion (44.7%), nausea and vomiting (47.6%), and neck pain (42.5%) with a heart attack. Higher knowledge levels were independently associated with higher levels of education (p=0.007), a history of angina (p=0.001), and attitudes (p=<0.001) and beliefs (p=<0.001) that are consistent with positively decisive responses to ACS symptoms.
Conclusion:
Despite having experienced an ACS event, overall knowledge levels were poor. Higher knowledge levels were associated with better attitudes and beliefs, indicating the inextricable relationship between all three components. Educational programmes should incorporate all three components so that prompt behaviour can be initiated when symptoms arise.
AllenderSScarboroughPPetoV. European cardiovascular disease statistics. Brussels: European Heart Network, 2008.
2.
MoserDKKimbleLPAlbertsMJ. Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart Association council on cardiovascular nursing and stroke council. Circulation2006; 114(2): 168–182.
3.
DeVonHHoganNOchsA. Time to treatment for acute coronary syndromes: the cost of indecision. J Cardiovasc Nurs2010; 25(2): 106–114.
4.
KhraimFCareyM. Predictors of pre-hospital delay among patients with acute myocardial infarction. Patient Educ Couns2009; 75: 155–161.
5.
RiegelBMcKinleySMoserD. Psychometric evaluation of the acute coronary syndrome (ACS) response index. Res Nurs Health2007; 30(6): 584–94.
6.
JensenLMoserD. Gender differences in knowledge, attitudes, and beliefs about heart disease. Nurs Clin North Am2008; 43: 77–104.
7.
Oxford Dictionaries. Concise Oxford english dictionary. Oxford: Oxford University Press, 2011.
8.
GoffDCJrSellersDEMcGovernPG. Knowledge of heart attack symptoms in a population survey in the United States: the REACT trial. Arch Intern Med1998; 158(21): 2329–2338.
9.
GreenlundKKeenanNGilesW. Public recognition of major signs and symptoms of heart attack: seventeen states and the US Virgin islands 2001. Am Heart J2004; 147: 1010–1016.
10.
DracupKMcKinleySDoeringL. Acute coronary syndrome: what do patients know?Arch Intern Med2008; 168(10): 49–54.
11.
HwangSRyanCZerwicJ. Korean immigrants’ knowledge of heart attack symptoms and risk factors. J Immigr Minor Health2008; 10: 67–72.
12.
CytrynKYoskowitzNCiminoJ. Lay public’s knowledge and decisions in response to symptoms of acute myocardial infarction. Adv Health Sci Educ Theory Pract2009; 14: 43–59.
13.
HenrikssonCLarssonMArnetzJ. Knowledge and attitudes towards seeking medical care for AMI-symptoms. Int J Cardiol2011; 147: 224–227.
14.
McKinleySDracupKMoserD. The effect of a short one-on-one nursing intervention on knowledge, attitudes and beliefs related to response to acute coronary syndrome in people with coronary heart disease: a randomized controlled trial. Int J Nurs Stud2009; 46(8): 1037–1046.
15.
CantoJGGoldbergRJHandMM. Symptom presentation of women with acute coronary syndromes: myth vs reality. Arch Intern Med2007; 167(22): 2405–2413.
16.
MoscaLMochari-GreenbergerHDolorR. Twelve-year follow-up of American women’s awareness of cardiovascular disease risk and barriers to heart health. Circ Cardiovasc Qual Outcomes2010; 3: 120–127.
17.
DoyleFDelaHarpeDMcGeeH. Nine-year comparison of presentation and management of acute coronary syndromes in Ireland: a national cross-sectional survey. BMC Cardiovasc Disord2005; 5(5): 1–8.
18.
O’DonnellSCondellSBegleyCM. Pre-hospital care pathway delays: gender and myocardial infarction. J Adv Nurs2006; 53(3): 268–276.
19.
LeupkerRRaczynskiJOsganianS. Effect of a community intervention on patient delay and emergency service use in acute coronary heart disease: the Rapid Early Action for Coronary Treatment (REACT) trial. JAMA2000; 284(1): 60–67.
20.
LeflerLLBondyKN. Women’s delay in seeking treatment with myocardial infarction: a meta-synthesis. J Cardiovasc Nurs2004; 19(4): 251–268.
21.
DracupKMoserDK. Beyond sociodemographics: factors influencing the decision to seek treatment for symptoms of acute myocardial infarction. Heart Lung1997; 26(4): 253–262.
22.
McKinleySDracupKMoserDK. International comparison of factors associated with delay in presentation for AMI treatment. Eur J Cardiovasc Nurs2004; 3(3): 225–230.
23.
HwangSYParkEHShinES. Comparison of factors associated with atypical symptoms in younger and older patients with acute coronary syndromes. J Korean Med Sci2009; 24(5): 789–94.
24.
MoserDKMcKinleySDracupK. Gender differences in reasons patients delay in seeking treatment for acute myocardial infarction symptoms. Patient Educ Couns2005; 56(1): 45–54.
25.
BanksADDracupK. Factors associated with prolonged pre-hospital delay of African Americans with acute myocardial infarction. Am J Crit Care2006: 15(2): 149–157.
26.
FinneganJRJrMeischkeHZapkaJG. Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five US regions. Prev Med2000; 31 (3): 205–213.
27.
MoscaLJonesWKingK. Awareness, perception and knowledge of heart disease risk and prevention among women in the United States. Arch Fam Med2000; 9: 506–515.
28.
MoscaLFerrisAFabunmiR. Tracking women’s awareness of heart disease: an American Heart Association national study. Circulation2004; 109: 573–579.
29.
ThuressonMJarlovMLindahlB. Thoughts, actions, and factors associated with pre-hospital delay in patients with acute coronary syndrome. Heart Lung2007; 36(6): 398–409.
30.
GoldbergRJO’DonnellCYarzebskiJL. Sex differences in symptom presentation associated with acute myocardial infarction: a population-based perspective. Am Heart J1998; 136(2): 189–195.
31.
CantoJGShlipakMGRogersWJ. Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA2000; 283(24): 3223–3229.
32.
HorneRJamesDPetrieK. Patients’ interpretation of symptoms as a cause of delay in reaching hospital during acute myocardial infarction. BMJ2000; 83(4): 388–393.
33.
MilnerKAVaccarinoVArnoldAL. Gender and age differences in chief complaints of acute myocardial infarction (Worcester heart attack study). Am J Cardiol2004; 93(5): 606–608.
34.
BriegerDEagleKGoodmanS. Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the global registry of acute coronary events. Chest2004; 126: 461–469.
35.
VandeWerfFArdissinoDBetriuA. Management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force on the management of acute myocardial infarction of the European Society of Cardiology. Eur Heart J2008; 29(23): 2909–45.
36.
LozziLCarstensenSRasmussenH. Why do acute myocardial infarction patients not call an ambulance?: an interview with patients presenting to hospital with acute myocardial infarction symptoms. Intern Med J2005; 35: 668–671.
37.
KerrDHoldenDSmithJ. Predictors of ambulance use in patients with acute myocardial infarction in Australia. Emerg Med J2006; 23: 948–952.
38.
LiSDa-yiHHong-bingY. Influence of ambulance use on early reperfusion therapies for acute myocardial infarction. Chinese Med J2008; 121(9): 771–775.
39.
Fox-WasylyshynSMEl-MasriMArtinianNT. Testing a model of delayed care-seeking for acute myocardial infarction. Clin Nurs Res2010; 19(1): 38–54.
