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Many Americans unaware of MI signs, symptoms
Nearly half of all U.S. citizens do not know the five signs and symptoms of MI and, depending on the sociodemographic subgroup, may not know any at all, according to research published in JAMA Network Open.
In a cross-sectional study that used data from the 2017 National Health Interview Survey, researchers found that 53% of U.S. adults were aware of all five symptoms of MI (95% CI, 51.9-54.1) while 20.3% were not aware of the three most common symptoms (95% CI, 19.4-21.3) and 5.8% were not aware of any symptoms (95% CI, 5.2-6.4).
The five signs and symptoms of MI are:
- chest pain or discomfort;
- shortness of breath;
- pain or discomfort in arms or shoulders;
- feeling weak, lightheaded or faint; and
- jaw, neck or back pain.
Moreover, researchers observed that lack of awareness of any symptoms was associated with male sex (OR = 1.23; 95% CI, 1.05-1.44), Hispanic ethnicity (OR = 1.89; 95% CI, 1.47-2.43), birth outside the U.S. (OR = 1.85; 95% CI, 1.47-2.33) and lower education level (OR = 1.31; 95% CI, 1.09-1.58).
“To our knowledge, this study is the first to describe awareness rates across such diverse sociodemographic subgroups based on socioeconomic status, insurance status and immigration status,” Shiwani Mahajan, MBBS, postdoctoral associate at the Yale School of Medicine, and colleagues wrote. “We found significant disparities across subgroups based on age, race/ethnicity, and education level [and] identified non-U.S.-born individuals, uninsured individuals, and individuals from the low-income and lowest-income subgroups as high-risk subgroups for not being aware of any symptoms.”
Awareness among subgroups
In other findings, among non-Hispanic black or Hispanic individuals who were not born in the U.S., in a low-income or lowest-income subgroup, had no insurance and had a lower education level, 17.9% (95% CI, 13.3-23.6) were not aware of any symptoms of MI. According to the study, this subgroup had more than a sixfold greater odds of not being aware of any symptoms (OR = 6.34; 95% CI, 3.92-10.26) compared with the rest of the cohort.
“We found that nearly 1 in 8 (12%) of the estimated 5 million non-U.S.-born individuals were not aware of any symptoms and that acculturation factors had a significant association with awareness among immigrants,” the researchers wrote. “Given the increasing number of individuals in the U.S. who were born in other countries and the low symptom awareness rates among these individuals, public health professionals may need to tailor awareness campaigns according to these individuals’ linguistic and cultural needs.”
Response to MI symptoms
In addition to MI symptom awareness, researchers also assessed participants’ choice of whether or not to call emergency medical services (EMS) in response to these symptoms. They observed that 4.5% (95% CI, 4-5) chose a different reaction than calling EMS in response to a MI.
“As expected, individuals who were unaware of the symptoms were also more likely to not call EMS; however, a significant number of adults with optimal symptom awareness also chose to not call EMS,” the researchers wrote. “Some possible explanations for this could be denial of symptoms, misattribution to symptoms to a noncardiac cause, perceived loss of control and ability to act, self-treatment strategies, fear or embarrassment of being wrong and concerns about cost. Given that early intervention in patients with MI is crucial to limit ischemic damage, prompt recognition of MI symptoms and rapid decision to seek care can reduce delays from symptom-onset to hospital presentation and improve survival.”
Using respondent data (52% women; 70% non-Hispanic white; 83% U.S.-born) from the 2017 National Health Interview Survey, researchers aimed to assess the characteristics and percentage of individuals unaware of MI symptoms and/or chose to call EMS in response to these symptoms.
“Recognizing the subgroups that are at the highest risk of being unaware of MI symptoms is germane to the current debate regarding diminishing treatment delays for individuals experiencing a MI and can help better design health care policies and/or campaigns specifically tailored for them,” the researchers wrote. – by Scott Buzby
Disclosures: Mahajan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.