Healthy People 2020 (HP2020), the primary objectives monitoring the nation’s health, has called for increased awareness of the early warning signs and symptoms of a heart attack and the importance of accessing emergency care by dialing 9-1-1. 1 Poor knowledge of the signs and symptoms of a heart attack has been associated with delayed hospital admission and unfavorable health outcomes.2 There are five classic symptoms of heart attack: 1) pain or discomfort in the jaw, neck or back; 2) feeling weak, lightheaded or faint; 3) chest pain or discomfort; 4) pain or discomfort in the arms or shoulder; and 5) shortness of breath.3 Healthy People 2020 (HP2020), the primary objectives monitoring the nation’s health, has called for increased awareness of the early warning signs and symptoms of a heart attack and the importance of accessing emergency care by dialing 9-1-1.1 To complement national objectives, it is important to understand sociodemographic disparities associated with the awareness of the signs and symptoms to target public health messages. To address this gap, we used data from the National Health Interview Survey (NHIS) in 2008 and 2014 to: 1) assess the disparities in the prevalence of awareness of signs and symptoms of a heart attack and calling 9-1-1 in 2014; and 2) determine the change in prevalence of awareness of the signs and symptoms of a heart attack and calling 9-1-1 between 2008 and 2014.
We accessed the recommended heart attack knowledge, which was defined if the participants knew or were aware of all five heart attack symptoms and who knew or were aware of the importance of calling 9-1-1. The adjusted prevalence of having the recommended heart attack knowledge in 2014 are presented in the Table. Large disparities in having the recommended heart attack knowledge were noted by sex, age group, race/ethnicity, level of education, marital status, access to health care, region of residence, and history of coronary heart disease. After adjusting for sex, age, race/ethnicity, and education attainment, logistic regression models showed a significant absolute increase of 10.1% with recommended heart attack knowledge. Compared with 2008, participants in 2014 were 60% more likely to have the recommended heart attack knowledge. Compared to 2008, the odds ratio of change in recommended heart attack knowledge in 2014 ranged from 1.3 for those with history of heart attack to 1.9 for those with PIR less than 1.0.
Table 1.
Logistic Regression results to assess disparities in Recommended Heart Attack Knowledge in 2014 and changes between 2008 and 2014 - National Health Interview Survey
| Prevalence (2014) | Change in Prevalence (2008 and 2014) | |||||||
|---|---|---|---|---|---|---|---|---|
| Characteristics | % | (se) | OR | (95% CI) | % | (se) | OR | (95% CI) |
| Total | 47.2 | (0.5) | 10.1 | (0.6) | 1.6 | (1.47—1.64) | ||
| Sex | ||||||||
| Men | 43.3 | (0.6) | 1.0 | referent | 10.0 | (0.8) | 1.6 | (1.45—1.67) |
| Women | 50.9 | (0.6) | 1.4 | (1.30—1.46) | 10.2 | (0.8) | 1.6 | (1.44—1.67) |
| Age (years) | ||||||||
| 18–44 | 41.7 | (0.7) | 1.0 | referent | 9.5 | (0.9) | 1.5 | (1.42—1.67) |
| 45–64 | 52.7 | (0.7) | 1.6 | (1.47—1.72) | 10.7 | (1.0) | 1.6 | (1.44—1.71) |
| ≥65 | 51.0 | (0.9) | 1.5 | (1.35—1.62) | 10.8 | (1.3) | 1.6 | (1.41—1.73) |
| Race-Ethnicity | ||||||||
| Non-Hispanic White | 51.7 | (0.6) | 1.0 | referent | 9.7 | (0.8) | 1.5 | (1.40—1.60) |
| Non-Hispanic Black | 42.9 | (1.1) | 0.7 | (0.63—0.77) | 13.3 | (1.5) | 1.8 | (1.60—2.09) |
| Non-Hispanic Asian | 28.2 | (1.9) | 0.4 | (0.29—0.44) | 3.7 | (2.7) | 1.2 | (0.92—1.6) |
| Hispanic | 36.1 | (1.0) | 0.5 | (0.47—0.57) | 10.3 | (1.2) | 1.7 | (1.51—1.95) |
| Other | 41.6 | (1.8) | 0.7 | (0.56—0.77) | 13.4 | (2.8) | 1.8 | (1.42—2.38) |
| Completed Education (age ≥25 years) | ||||||||
| Less than High School | 39.9 | (1.2) | 0.6 | (0.56—0.70) | 12.0 | (1.4) | 1.8 | (1.56—2.05) |
| High School graduate | 44.9 | (0.8) | 0.8 | (0.72—0.85) | 9.8 | (1.3) | 1.5 | (1.37—1.70) |
| Some College | 50.7 | (0.7) | 1.0 | (0.92—1.08) | 10.7 | (1.1) | 1.6 | (1.43—1.72) |
| College graduate | 50.8 | (0.7) | 1.0 | referent | 8.4 | (1.2) | 1.4 | (1.29—1.56) |
| Family Income-Poverty Ratio (PIR)|| | ||||||||
| PIR <1.0 | 43.5 | (1.1) | 0.8 | (0.73—0.89) | 12.6 | (1.3) | 1.9 | (1.64—2.12) |
| 1.0 ≤PIR <2.0 | 46.0 | (1.0) | 0.9 | (0.82—0.98) | 10.9 | (1.3) | 1.6 | (1.43—1.83) |
| PIR ≥2.0 | 48.6 | (0.6) | 1.0 | referent | 10.1 | (0.8) | 1.5 | (1.43—1.64) |
| Marital Status | ||||||||
| Married or living with partner | 47.9 | (0.6) | 1.0 | referent | 9.2 | (0.8) | 1.5 | (1.38—1.58) |
| Not married or living with partner | 46.3 | (0.6) | 0.9 | (0.88—0.99) | 11.6 | (0.9) | 1.7 | (1.55—1.83) |
| Health Status | ||||||||
| Good to excellent | 47.3 | (0.5) | 1.0 | referent | 10.1 | (0.7) | 1.5 | (1.46—1.65) |
| Fair to poor | 47.2 | (1.0) | 1.0 | (0.92—1.09) | 10.0 | (1.3) | 1.5 | (1.37—1.71) |
| Health Care: Usual place | ||||||||
| Yes | 48.0 | (0.5) | 1.0 | referent | 10.0 | (0.7) | 1.5 | (1.44—1.62) |
| No | 42.3 | (1.1) | 0.8 | (0.71—0.86) | 10.4 | (1.4) | 1.7 | (1.45—1.94) |
| Health insurance | ||||||||
| Yes | 47.9 | (0.5) | 1.0 | referent | 9.9 | (0.7) | 1.5 | (1.43—1.62) |
| No | 43.0 | (1.0) | 0.8 | (0.74—0.89) | 10.3 | (1.3) | 1.7 | (1.46—1.90) |
| Deferred medical care due to cost | ||||||||
| Yes | 47.0 | (1.1) | 1.0 | (0.90—1.09) | 10.6 | (1.6) | 1.6 | (1.37—1.81) |
| No | 47.3 | (0.5) | 1.0 | referent | 10.0 | (0.7) | 1.5 | (1.45—1.64) |
| Region | ||||||||
| Northeast | 45.1 | (1.2) | 0.8 | (0.76—0.95) | 11.6 | (1.7) | 1.7 | (1.45—1.92) |
| Midwest | 47.6 | (1.0) | 0.9 | (0.85—1.05) | 7.8 | (1.3) | 1.4 | (1.24—1.56) |
| South | 49.0 | (0.7) | 1.0 | referent | 11.9 | (1.1) | 1.7 | (1.52—1.84) |
| West | 45.7 | (0.9) | 0.9 | (0.79—0.96) | 8.5 | (1.2) | 1.4 | (1.29—1.62) |
| History of Heart Attack (MI) | ||||||||
| Yes | 51.4 | (2.2) | 1.2 | (1.00—1.44) | 7.3 | (2.8) | 1.3 | (1.05—1.67) |
| No | 47.1 | (0.5) | 1.0 | referent | 10.2 | (0.7) | 1.6 | (1.47—1.65) |
| History of CHD | ||||||||
| Yes | 55.1 | (1.9) | 1.4 | (1.21—1.65) | 9.2 | (2.7) | 1.5 | (1.16—1.83) |
| No | 46.9 | (0.5) | 1.0 | referent | 10.2 | (0.7) | 1.6 | (1.46—1.65) |
National education campaigns highlight the role individuals play in the chain of survival, which include quick, accurate identification of the signs and symptoms of a heart attack and the importance of calling 9-1-1 emergency services to support health systems in implementing urgent, life-saving clinical measures upon patient arrival.4 Future studies should focus on efforts to develop strategies that target translating knowledge into action, emphasizing the seriousness of symptoms, reinforcing the importance of 9-1-1 emergency services access, and tackling psychological barriers (e.g., denial, embarrassment).5 Although HP 2020 benchmarks have been met for heart attack awareness, the results presented identify continuing disparities. Diverse, community-based and health system supported public education campaigns are needed to improve awareness and should be culturally tailored and linguistically appropriate for target audiences.
Acknowledgments
CDC Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Abbreviations:
- NHIS
National Health Interview Survey
- HP 2020
Healthy People 2020
- CHD
Coronary Heart Disease
- PIR
Family-income to poverty ratio
References
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