Survey Reveals Troubling Unawareness of Common MI Symptoms

The researchers identified economic and ethnic risk factors that they say should be used to refocus public education efforts.

Survey Reveals Troubling Unawareness of Common MI Symptoms

Roughly 6% of American adults cannot recognize any of the symptoms of MI and millions more are not aware of all the symptoms that should prompt them to seek immediate medical attention, a new survey shows.

Being uninsured, having a low income, and having low level of education were factors associated with a low awareness of MI symptoms, as were being of non-Hispanic black or Hispanic race/ethnicity, and being born outside the United States. Individuals with all of those characteristics were sixfold more likely to be unaware of any symptoms of MI compared with insured, white, US-born individuals with middle-to-high income levels and some education beyond high school.

In an interview, the study’s senior author Khurram Nasir, MD (Houston Methodist DeBakey Heart and Vascular Center, TX), said the results are deeply troubling.

“What we found was that 13.5 million individuals were not even aware of a single symptom of MI. That’s huge,” he said. “This group wouldn’t even consider chest pain or discomfort a symptom.” Approximately 500,000 people living in the US have all the risk factors associated with not recognizing MI when it’s happening, Nasir pointed out.

“Although we can improve the access and we can reduce disparities in best treatment, . . . if they are unaware of these basic symptoms, they remain vulnerable populations and this may be contributing to some of the gaps we are seeing in care in these groups,” he noted.

The study was published yesterday in JAMA Network Open and was headed by Shiwani Mahajan, MBBS (Yale School of Medicine, New Haven, CT).

Not Contacting EMS Increased in Those Unaware of Symptoms

The survey was based on the responses of more than 25,000 Americans who participated in the 2017 National Health Interview Survey. They were asked about awareness of specific MI symptoms and what to do if someone is experiencing MI.

Chest pain or discomfort was the most widely recognized symptom, with nearly 92% of survey participants recognizing it as a sign of MI. Jaw, neck, or back pain were the least-recognized symptoms, at just 62.6%. While 53% of people recognized all five symptoms, 5.8% could not name one.

What we found was that 13.5 million individuals were not even aware of a single symptom of MI. That’s huge. Khurram Nasir

Being born outside the United States lowered the odds of being aware of all five symptoms of MI, as did having poor English proficiency and having lived in the United States for less than 10 years. Living in the South as opposed to the Midwest also was associated with less symptom awareness.  

While the majority of survey respondents said their response to MI would be to call 9-1-1 or another emergency number, 4.5% of the total cohort said they would elect to drive to the hospital, or call a physician, spouse or family member first. Factors associated with not contacting emergency medical services (EMS) included age 65 years or older, male sex, not having been born in the United States, low education level, and being uninsured. Any of these factors coupled with being unaware of any of the symptoms of MI greatly increased the risk of not contacting EMS.

If the survey offered any good news it may be the signal that some public health campaigns like Go Red for Women are working, Mahajan and colleagues say. Compared with men, women were nearly 10% more likely to know the five basic symptoms of MI (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) and more apt to contact EMS.

“It shows the success of these very targeted campaigns, but most of them have been focused primarily on women,” Nasir said. “We need to come together and say how can we best reach out to the uninsured, the low-income and low-education populations, and apparently also the non-white males.”

  • Mahajan and Nasir report no relevant conflicts of interest.