Original Article
Patients’ Understanding of their Heart Attack and the Impact of Exposure to a Media Campaign on Pre-Hospital Time

https://doi.org/10.1016/j.hlc.2014.07.063Get rights and content

Background

Patients with acute myocardial infarction (AMI) have a limited understanding of AMI symptoms and risk factors. This can lead to delays in the recognition of an AMI and hospital presentation. We aimed to assess patients’ understanding of their AMI symptoms and risk factors and also assess the impact of exposure to a media campaign on their pre-hospital time.

Methods

We surveyed 100 AMI patients admitted to the Canberra Hospital. We asked them about their AMI symptoms and risk factors and the impact of the National Heart Foundation (NHF) advertisements on their AMI experience.

Results

Only 26% of patients recognised that they were having an AMI. In 34% of cases, an ambulance was called. There was no significant difference in the median pre-hospital time between patients who encountered the NHF advertisements and those who had not (133 minutes vs. 137 minutes, p = 0.809). Only 22% of patients could identify all of their personal AMI risk factors.

Conclusions

Most AMI patients do not initially recognise their condition nor do they call for an ambulance. Exposure to the NHF advertisements had no significant influence on reducing pre-hospital time in this cohort. Most patients have a limited understanding of AMI risk factors and causes.

Introduction

Treatment with percutaneous coronary intervention or fibrinolytic therapy within one to two hours of onset of acute myocardial infarction (AMI) can reduce AMI related mortality by 50% [1], [2], [3]. However, these benefits diminish with time delays [4]. Calling for an ambulance shortly after the onset of AMI symptoms reduces the time to treatment [5], [6]. Therefore timely access to AMI therapies and a better prognosis depend upon patients quickly recognising their AMI symptoms and calling for an ambulance [7], [8].

The pre-hospital time represents the time from AMI symptom onset to arrival at hospital [1]. Unfortunately, over half of AMI patients delay seeking medical care for greater than six hours and patient decision time is responsible for most of this delay [1], [9]. Potential reasons for the lack of recognition of an AMI may be a poor awareness of AMI symptoms and lack of awareness of one's personal risk factors for AMI. Studies have shown that patients’ awareness of certain AMI symptoms can be high, however, awareness of all AMI symptoms was lower [7], [8]. Previous research has also suggested that patients lack knowledge regarding certain AMI risk factors such as diabetes and they also have a poor understanding of the cause(s) of their AMI [10], [11], [12]. Only a small proportion of patients knew to call emergency services in the event of an AMI [8].

Recently the National Heart Foundation (NHF) in Australia initiated the “Warning Signs of Heart Attack” media campaign which ran from 2008 to 2012. The campaign featured nationally and included television advertisements as well as radio, press and internet advertisements and fact sheets. This campaign aimed to raise awareness of AMI symptoms and to reduce the time taken for a person to recognise these symptoms and call an ambulance.

We aimed to investigate patients’ perceptions of their AMI symptoms and their initial reactions following the onset of these symptoms. We also aimed to assess the impact of exposure to the NHF advertisements on pre-hospital time in our patients. Patients’ understanding of the risk factors that may have contributed to their AMI was also examined.

Section snippets

Study Population and Setting

This was a prospectively conducted study which took place at the Canberra Hospital in Australia. Participants were patients (n = 100) admitted to the Coronary Care Unit (CCU) with a diagnosis of AMI between November 2011 to July 2012. All participants gave written informed consent to take part in the study.

Procedure

AMI patients were identified by the research team or CCU staff according to their admission diagnosis. The patients were unselected but not in a consecutive manner due to the constraints of

Results

Baseline characteristics for the cohort as well as a comparison of patients who had or had not encountered the NHF media campaign are summarised in Table 1. There was a preponderance of males among patients who had not seen the advertisements (100% male compared with 79% in those who had seen the advertisements, p = 0.0031). The two groups were well matched with regards to age and baseline risk factors except for a lower proportion of reported history of hypertension in the group which had not

Discussion

Our study has shown that only 26% of patients recognised their AMI at the time, and only in 34% of all cases was an ambulance called. This lack of recognition is likely a major contributor to delays in seeking medical attention as evidenced by a median pre-hospital time of 134 minutes. This pre-hospital delay is similar to those found in other Australian and international studies and does not appear to have changed greatly in the last two decades [1], [5], [9], [14]. Furthermore, recent data

Conclusion

Most AMI patients do not realise that they are experiencing an AMI and do not call for an ambulance. There was no significant difference in the median pre-hospital time in patients who had encountered the NHF advertisements and those who had not. Patients were able to identify most of their risk factors, however, few were able to identify all their risk factors.

Further research is needed to determine the economic feasibility of providing universal ambulance cover for all Australians. Future

Declaration of conflicts of interest

There are no conflicts of interest to declare.

Funding

This study did not receive funding from any sources.

Acknowledgements

We would like to acknowledge Pearle Taverner and Paul Marley of the Cardiology Research Unit and the nurses of the CCU at the Canberra Hospital. We would also like to acknowledge the contribution made by Dr. Terry Neeman of the ANU Statistical Consulting Unit.

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