WINSTON-SALEM, N.C. -- While most people are aware that chest pain is a heart attack symptom, other heart attack symptoms are often ignored, according to results from a multi-center study published today (Nov. 23, 1998) in Archives of Internal Medicine, a publication of the American Medical Association.
These other symptoms include numbness or pain in the arm, shortness of breath, and sweating, nausea or vomiting, dizziness or lightheadedness and five others, according to the principal author, David C. Goff Jr., M.D., Ph.D., associate professor of public health sciences (epidemiology) at Wake Forest University School of Medicine.
The issue is critical because clotbusters -- drugs that can reverse a heart attack in progress -- only work for a limited time after a heart attack begins. Delay may mean permanent heart damage, or even death.
"Knowledge of chest pain as an important heart attack symptom is high and relatively uniform," said Goff. "However, knowledge of the complex constellation of heart attack symptoms is deficient in the U.S. population, especially in socioeconomically disadvantaged and race or ethnic minority groups."
Goff also said that even people who are at higher risk of heart attacks -- such as those with diabetes, high blood pressure, high cholesterol levels or who are currently smoking cigarettes -- "do not demonstrate greater knowledge of heart attack symptoms than lower-risk persons."
He said, "This disappointing finding supports the conclusion that health care professionals are not targeting these patients effectively for education about heart attack symptoms."
Goff said clinical trials had demonstrated that clot-busters work well when used within the first six hours after a heart attack begins, but their value diminishes rapidly after six hours. "Approximately 22 percent of heart attack patients delay seeking care for at least six hours following the onset of symptoms," Goff said.
The study, called REACT (for Rapid Early Action for Coronary Treatment) involved surveying 1,294 adults in 20 communities. The investigators found that regardless of age, race, education, or household income, nearly nine out of ten people knew chest pain is a heart attack symptom.
But knowledge of the next most common heart attack symptom, arm pain or numbness, varied widely. More than three-quarters of the middle and upper income people surveyed knew arm pain or numbness was a symptom, compared to just half of those with incomes under $25,000. Three-quarters of whites knew, compared to 47 percent of African-Americans and 51.7 percent of Hispanics.
Half of the people from virtually all demographic divisions recognized shortness of breath as a symptom, but recognition that unexplained profuse sweating was a heart attack symptoms varied widely, from 24.9 percent among whites to 12.3 percent among African-Americans and 10.6 percent among Hispanics. Nearly one-third of those with incomes over $55,000 recognized sweating as a symptom, compared to just 12.8 percent of those with incomes under $25,000.
Those people who had a personal history of heart disease, or previous experience with heart disease in the family or in a close friend or relative generally did better in recognition of heart attack symptoms -- but even they did not have complete knowledge.
Goff said that ways must be designed to teach the complex constellation of heart attack symptoms to minorities, lower income people and those who are at high risk.
He said that stories by role models based on the experiences of real heart attack victims may help in making these symptoms clear. Then, he said, people have to take this knowledge of heart attack symptoms and translate it into rapidly taking action when symptoms appear.
The goal: to increase the number and percentage of people with heart attacks who get to the hospital soon enough to benefit from clot-busting drugs and other treatments that only work well for a few hours after a heart attack begins.
The study was paid for by the National Heart Lung and Blood Institute.
Contact: Robert Conn, Jim Steele or Mark Wright at 336-716-4587
Journal
Archives of Internal Medicine