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PubMed1988

The role of risk factors in heart attacks occurring in men with pre-existing ischaemic heart disease.

The importance of three risk factors--serum total cholesterol, systolic blood pressure, and cigarette smoking--on the risk of new major ischaemic heart disease events in men who already have evidence of ischaemic heart disease was assessed. Data from the initial examination in a large prospective study of cardiovascular disease in middle aged men (the British Regional Heart Study) were used to separate 7710 men into three groups on the basis of a resting electrocardiogram, a standardised chest pain questionnaire, and recall of a doctor's diagnosis of angina or of a previous heart attack: (group 1) no evidence of ischaemic heart disease (75%), (group 2) evidence of ischaemic heart disease short of a definite myocardial infarction (20%), (group 3) definite myocardial infarction (6%). In the average follow up period of 7.5 years, 443 men suffered a new major event caused by ischaemic heart disease (fatal or non-fatal myocardial infarction or sudden cardiac death). Age standardised event rates were determined for each of the three groups for varying levels of the established risk factors. Cigarette smoking is strongly associated with the event rate in group 1 but in men with existing heart disease, especially group 3, differences in risk between the smoking categories were smaller. The strong relation between systolic blood pressure and event rate persisted in groups 1 and 2 but not in group 3. The positive association between serum concentration of total cholesterol and the event rate was strongest in group 1 and weaker in groups 2 and 3, though it remained highly significant. These observations, taken together with the results of previous prospective studies and intervention trials, suggest that the important association between serum total cholesterol and the risk of heart attack persists in men with pre-existing ischaemic heart disease, including myocardial infarction. Therefore, in these men the reduction of serum total cholesterol concentration may be at least as important as it is in men without evidence of ischaemic heart disease.

Adult↗
PubMed1986

Family history of heart attack: a modifiable risk factor?

A family history of heart attack is reported to be an independent predictor of cardiovascular death in men. In a 9 year follow-up of 4014 adults from 40 to 79 years old in the Rancho Bernardo Study, men under 60 years of age with a family history of heart attack were at fivefold increased risk. In this study, we sought to determine whether modifiable risk factors, i.e., blood pressure, plasma cholesterol, obesity, and cigarette smoking, have a differential effect on cardiovascular risk in those with and without a family history of heart attack. For both sexes, cigarette smoking was a stronger predictor of cardiovascular disease in those with a family history of heart attack (relative risk of smokers vs nonsmokers was 2.5 for men and 4.0 for women) than in those with no such family history (relative risk of smokers vs nonsmokers was 1.1 for men and 1.7 for women). Conversely, an increased risk of cardiovascular mortality in men with a family history of heart attack was present predominantly in smokers (relative risk related to positive family history was 1.2 in nonsmokers, and 3.3 in smokers). An estimated 68% of the excess deaths in men with a family history of heart attack were attributable solely to the interaction of family history with smoking habit and were therefore potentially avoidable. The risk of cardiovascular disease associated with an apparently inherited predisposition appears to be profoundly affected by modifiable behavior.

Adult↗
PubMed2003

Self-reported heart attack in Mexican-American elders: examination of incidence, prevalence, and 7-year mortality.

OBJECTIVES: To examine the prevalence, incidence, and mortality of self-reported heart attack in older Mexican Americans and to identify significant factors associated with heart attack. DESIGN: Cross-sectional and longitudinal study. SETTING: Baseline and three follow-up interviews in five southwestern states (Arizona, California, Colorado, New Mexico, and Texas) of the Hispanic Established Population for the Epidemiological Study of the Elderly. PARTICIPANTS: Three thousand fifty Mexican Americans aged 65 to 107 (mean age = 73). MEASUREMENTS: Sociodemographic factors (age, sex, marital status, language of interview, health insurance coverage, living arrangements, and financial strain) and health factors (smoking, alcohol consumption, obesity, diabetes mellitus, hypertension, stroke, cancer, hip fracture, arthritis, depression, limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and mortality) were determined at baseline (1993-94). New heart attacks were assessed at follow-ups in 1995-96, 1998-99, and 2000-01. Vital status was determined over the 7-year follow-up. RESULTS: Prevalence of self-reported heart attack was 9.1% at baseline. Incidence of self-reported heart attack was 6.1%, 9.1%, and 7.9%, respectively, for the three subsequent follow-ups. Older age, male sex, diabetes mellitus, hypertension, and stroke were significantly associated with heart attack at baseline. Age was a significant predictor for new heart attack at each follow-up. Having ADL (odds ratio (OR) = 2.91, 95% confidence interval (CI) = 2.19-3.86) and IADL (OR = 2.25, CI = 1.72-2.94) disabilities was significantly associated with self-reported heart attack. Subjects with heart attack were significantly more likely to die at 7 years (hazard ratio = 1.57, 95% CI = 1.29-1.91). Of those with self-reported heart attack, 42.4% had died of heart attack as the underlying cause of death by 7-year follow-up. CONCLUSION: In Mexican Americans, self-reported heart attack was associated with being older and male and having diabetes mellitus, hypertension, stroke, and ADL and IADL disabilities. Nearly half of subjects with heart attack had died of heart attack as underlying cause of death by 7-year follow-up. Prevention and control for this disease would be especially important in this population to avoid early mortality.

Aged↗
PubMed2002

The structure of beliefs about the causes of heart attacks: A network analysis.

OBJECTIVES: To explore the structure of causal beliefs about heart attack, using network analysis, in particular to determine whether there is a consensual representation and, if so, which putative causes of heart attacks were perceived as being proximal or distal causes and which were perceived to mediate the effects of other causes. METHODS: A total of 107 adult respondents completed questionnaires, indicating the extent to which they perceived each of eight agents as causes of a heart attack, as well as whether they perceived that each of these eight causal agents, in turn, causally affects each of the other seven causal agents. RESULTS: A consensual representation was produced, indicating how these eight agents were perceived as causally relating to each other, and to heart attack. Three key features were evident. First, the type of work a person does was perceived to be a distal cause of heart attack, operating mainly through stress and high blood pressure. Second, the causal impact of stress on heart attack was not seen as mediated by behaviour, but mediated via blood pressure. Third, the causal impact of genes on heart attack was perceived as unmediated by behaviour or physiological processes. CONCLUSIONS: The general public appears to share a reasonably complex view of how different agents lead to heart attack. This complexity would not be elicited by standard methods, suggesting that the network analysis method may be usefully employed as either a process or an outcome measure in health-promotion research.

Journal Article↗
PubMed2000

Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five U.S. regions.

BACKGROUND: Patient delay in seeking health care for heart attack symptoms is a continuuing problem in the United States. METHODS: Investigators conducted focus groups (N = 34; 207 participants) in major U.S. regions (NE, NW, SE, SW, MW) as formative evaluation to develop a multi-center randomized community trial (the REACT Project). Target groups included adults with previous heart attacks, those at higher risk for heart attack, and bystanders to heart attacks. There were also subgroups reflecting gender and ethnicity (African-American, Hispanic-American, White). FINDINGS: Patients, bystanders, and those at higher risk expected heart attack symptoms to present as often portrayed in the movies, that is, as sharp, crushing chest pain rather than the more common onset of initially ambiguous but gradually increasing discomfort. Patients and those at higher risk also unrealistically judge their personal risk as low, understand little about the benefits of rapid action, are generally unaware of the benefits of using EMS/9-1-1 over alternative transport, and appear to need the "permission" of health care providers or family to act. Moreover, participants reported rarely discussing heart attack symptoms and appropriate responses in advance with health care providers, spouses, or family members. Women often described heart attack as a "male problem," an important aspect of their underestimation of personal risk. African-American participants were more likely to describe negative feelings about EMS/9-1-1, particularly whether they would be transported to their hospital of choice. CONCLUSIONS: Interventions to reduce patient delay need to address expectations about heart attack symptoms, educate about benefits and appropriate actions, and provide legitimacy for taking specific health care-seeking actions. In addition, strategy development must emphasize the role of health care providers in legitimizing the need and importance of taking rapid action in the first place.

Adaptation, Psychological↗
PubMed1978

Physical activity as an index of heart attack risk in college alumni.

Risk of first heart attack was found to be related inversely to energy expenditure reported by 16,936 Harvard male alumni, aged 35-74 years, of whom 572 experienced heart attacks in 117,680 person-years of followup. Stairs climbed, blocks walked, strenuous sports played, and a composite physical activity index all opposed risk. Men with index below 2000 kilocalories per week were at 64% higher risk than classmates with higher index. Adult exercise was independent of other influences on heart attack risk, and peak exertion as strenuous sports play enhanced the effect of total energy expenditure. Notably, alumni physical activity supplanted student athleticism assessed in college 16-50 years earlier. If it is postulated that varsity athlete status implies selective cardiovascular fitness, such selection alone is insufficient to explain lower heart attack risk in later adult years. Ex-varsity athletes retained lower risk only if they maintained a high physical activity index as alumni.

Adult↗
PubMedDate not supplied

The effect of nursing professional pay structures and pay levels on hospitals' heart attack outcomes.

The effect of nursing professionals (i.e., nurse aid/orderly, licensed practical nurse, registered nurse) pay structures and pay levels on hospitals risk-adjusted heart attack outcomes was determined. Operationalizing hospitals' heart attack outcomes as their thirty-day risk-adjusted mortality rates, a positive curvilinear relation is hypothesized between pay dispersion and hospitals' heart attack outcomes, whereas a direct relation is hypothesized between pay level and hospitals' heart attack outcomes. Pay level is also hypothesized as a moderator of the relation between pay dispersion and hospitals' heart attack outcomes. Using a sample of 138 California hospitals, support is not found for either the curvilinear relation between hospitals' nursing professionals pay dispersion and hospitals' heart attack outcomes, or the direct relation between nursing professionals' pay level and hospitals' heart attack outcomes. Support is found for the moderation hypothesis in which nursing professionals' pay level moderates the relation between hospitals' nursing professionals pay dispersion and hospitals' heart attack outcomes. Implications for practice are discussed in light of the study's results.

California↗
PubMed1985

Impact of a health education program and other factors on stopping smoking after heart attack.

A prospective follow-up study was carried out to investigate the impact of a health education program and other factors related to patient's social background and severity of heart attack on stopping smoking after heart attack. The study consisted of male patients below the age of 65 years, who had suffered a heart attack between April 1 and September 30, 1977, living in two provinces of eastern Finland, North Karelia and Kuopio. Of the patients who smoked before the heart attack, 102 responded to both the 6- and the 12-month follow-up postal survey. Of these 102 patients, 25 stopped smoking within 12 months after the heart attack, while 77 continued to smoke. Continuing smoking was most strongly associated with working and unemployment before heart attack, maximum serum aspartate aminotransferase (GOT) concentration and subjective recovery after the heart attack. The quitting rate among men in the program area was 1.2-fold (p = 0.012) compared with the reference area men, after making allowance for the seven most confounding factors in the multivariate analysis. This observation indicates that either the community-based primary program or the secondary prevention program in North Karelia succeeded in dissuading patients from smoking after heart attack.

Adult↗
PubMed2004

Public recognition of major signs and symptoms of heart attack: seventeen states and the US Virgin Islands, 2001.

BACKGROUND: Timely access to emergency cardiac care and survival is partly dependent on early recognition of heart attack symptoms and immediate action by calling emergency services. We assessed public recognition of major heart attack symptoms and knowledge to call 9-1-1 for an acute event. METHODS: Data are from the 2001 Behavioral Risk Factor Surveillance System, a state-based telephone survey. Participants (n = 61,018) in 17 states and the U.S. Virgin Islands indicated whether the following were heart attack symptoms: pain or discomfort in the jaw, neck, back; feeling weak, lightheaded, faint; chest pain or discomfort; sudden trouble seeing in 1 or both eyes (false symptom); pain or discomfort in the arms or shoulder; shortness of breath. Participants also indicated their first action if someone was having a heart attack. RESULTS: Most persons (95%) recognized chest pain as a heart attack symptom. However, only 11% correctly classified all symptoms and knew to call 9-1-1 when someone was having a heart attack. Symptom recognition and the need to call 9-1-1 was lower among men than women, persons of various ethnic groups than whites, younger and older persons than middle-aged persons, and persons with less education. Persons with high blood pressure, high cholesterol, diabetes mellitus, or prior heart attack or stroke were not appreciably more likely to recognize heart attack symptoms than were persons without these conditions. CONCLUSIONS: Public health efforts are needed to increase recognition of the major heart attack symptoms in both the general public and groups at high risk for an acute event.

Adult↗
PubMed2006

Effect of language on heart attack and stroke awareness among U.S. Hispanics.

BACKGROUND: Hispanics with acute heart attack or stroke have longer delay times to hospital arrival, and are thus less likely to benefit from time-dependent reperfusion therapies. Delay time is influenced largely by recognition of warning symptoms and activation of the 911 system. Previous studies suggest poor symptom recognition among racial/ethnic minorities, but very little is known about heart attack and stroke knowledge among Hispanics, or the influence of English language proficiency on cardiovascular emergency awareness. METHODS: Cross-sectional analysis (conducted in 2005) of data from the 2003 Behavioral Risk Factor Surveillance System population survey was limited to states with Spanish-language interviews. Principal study outcomes were the correct identification of five heart attack and five stroke warning symptoms, and intention to call 911 for a suspected event. Subjects included 698 English-speaking Hispanics, 527 Spanish-speaking Hispanics, and 24,201 non-Hispanics. RESULTS: Spanish-speaking Hispanics are far less likely to know all heart attack symptoms (7%) than English-speaking Hispanics (23%), non-Hispanic blacks (28%), and non-Hispanic whites (39%) (p<0.001); and far less likely to know all stroke symptoms (18%) than English-speaking Hispanics (31%), non-Hispanic blacks (41%), and non-Hispanic whites (50%) (p<0.001). Intention to call 911 did not differ significantly among groups. Spanish-speaking Hispanics remain significantly less likely than all other groups to correctly identify symptoms after adjustment for sociodemographic characteristics, healthcare access, and cardiovascular risk factors (p<0.05). CONCLUSIONS: Lack of English proficiency is strongly associated with lack of heart attack and stroke knowledge among Hispanics. This highlights the need for educational intervention about cardiovascular emergencies targeted to Spanish-speaking communities.

Adult↗
PubMed1999

Association between extent of periodontal attachment loss and self-reported history of heart attack: an analysis of NHANES III data.

Coronary heart disease is responsible for one of every five deaths in the United States. Recent epidemiological studies have shown an association between periodontal disease and coronary heart disease. The purpose of this cross-sectional study was to verify this association using data from the third National Health and Nutrition Examination Survey (NHANES III). Data for 5564 people 40 years of age and older who had complete periodontal assessments and information on heart attack were evaluated. The outcome was the self-reported history of heart attack (yes vs. no). The main independent variable was the percent of periodontal sites per person with attachment loss of 3 mm or greater (categorized as 0%, > 0-33%, > 33-67%, and > 67%). Periodontal attachment loss was measured at two sites per tooth in randomly assigned half-mouths, one upper and one lower quadrant. The covariables included sociodemographic variables and established risk factors for cardiovascular disease. Relative to the 0% category, the unadjusted odds of heart attack increased with each higher category of attachment loss-2.2 (95% confidence interval = 1.3-3.8), 5.5 (3.4-9.1), and 9.8 (4.5-21.0), respectively. Adjustment for age, sex, race, poverty, smoking, diabetes, high blood pressure, body mass index, and serum cholesterol decreased these odds to 1.4 (0.8-2.5), 2.3 (1.2-4.4), and 3.8 (1.5-9.7), respectively. This study supports findings from previous studies of an association between periodontal disease and coronary heart disease.

Adult↗
PubMed2004

Increasing employee awareness of the signs and symptoms of heart attack and the need to use 911 in a State Health Department.

INTRODUCTION: Early recognition of the signs and symptoms of a heart attack can lead to reduced morbidity and mortality. METHODS: A workplace intervention was conducted among 523 Montana state health department employees in 2003 to increase awareness of the signs and symptoms of heart attack and the need to use 911. All employees received an Act in Time to Heart Attack Signs brochure and wallet card with their paychecks. Act in Time posters were placed in key workplace areas. A weekly e-mail message, including a contest entry opportunity addressing the signs and symptoms of heart attack, was sent to all employees. Baseline and follow-up telephone surveys were conducted to evaluate intervention effectiveness. RESULTS: Awareness of heart attack signs and symptoms and the need to call 911 increased significantly among employees from baseline to follow-up: pain or discomfort in the jaw, neck, or back (awareness increased from 69% to 91%); feeling weak, light-headed, or faint (awareness increased from 79% to 89%); call 911 if someone is having a heart attack or stroke (awareness increased from 84% to 90%). Awareness of chest pain, pain or discomfort in the arms or shoulders, and shortness of breath were more than 90% at baseline and did not increase significantly at follow-up. At baseline, 69% of respondents correctly reported five or more of the signs and symptoms of heart attack; 89% reported correctly at follow-up. CONCLUSION: This low-cost workplace intervention increased awareness of the signs and symptoms of heart attack and the need to call 911.

Adult↗
PubMed1998

Validation of patient recall of doctor-diagnosed heart attack and stroke: a postal questionnaire and record review comparison.

Few studies have assessed the accuracy of patient recall of doctor-diagnosed heart attack and stroke on postal questionnaire, yet such data are widely used in epidemiologic studies. In the national prospective British Regional Heart Study of 7,735 men aged 40-59 years, based in general practice and followed up for a mean 13.8 years, a mailed questionnaire was sent to all available survivors in 1992. Patient recall of doctor-diagnosed heart attack and stroke was compared with the 316 new general practice-reported heart attacks and 102 new general practice-reported strokes from the medical record reviews. Both study and general practice records were checked for all discordant findings, and corrections were made to the study database. Patients tended to overrecall major cardiovascular events more than they underrecalled them, 33% versus 6% for heart attacks and 25% versus 11% for strokes. Among overrecalled heart attacks, other circulatory problems were present in 78% of the subjects; transient ischemic attacks accounted for 57% of overrecalled strokes. In contrast, the general practice record review system tended to underreport events rather than to overreport them, 3% versus 0.3% for heart attacks and 23% versus 5% for strokes. Patient recall of doctor-diagnosed heart attack and stroke provides a useful method for estimating prevalence rates and resource needs, but the tendency to overestimation needs to be recognized. In etiologic studies when strict diagnostic case criteria are essential, patient recall should be used to complement rather than to supplant medical record data.

Adult↗
PubMed1989

Accuracy of perceptions of heart attack risk: what influences perceptions and can they be changed?

Using perceived risk of a heart attack, we examined the relative importance of perceived risk factors and sociodemographic variables on subjects' perception of heart attack risk, the relationship between perceived and objectively measured heart attack risk, and the effect of health risk appraisal (HRA) feedback on risk perceptions. Data derive from a random sample of 732 Greater Boston, Massachusetts area men and women ages 25-65 years, who participated in a field trial of health risk appraisal instruments. At baseline and approximately two months later, all respondents completed a questionnaire assessing their own health-related behavior, risk factors, and perception of heart attack risk. At baseline, respondents also completed one of four HRA instruments. Physiologic measures of cholesterol, blood pressure, and weight were taken at either baseline or follow-up visit. Results showed that respondents used established risk factors in estimating overall risk; that compared to objective measures of risk, a high percentage of respondents displayed an optimistic bias; and that HRA feedback had some effect on perception of heart attack risk for those at high risk. Implications of these results for health promotion are discussed.

Adult↗
PubMed1990

Considerations for a national heart attack alert program.

Coronary heart disease (CHD) remains the leading cause of death in the United States--in women as well as men. In 1987, CHD was responsible for 512,138 deaths, of which 253,542 deaths were attributed to acute myocardial infarction (AMI) and accounted for over $43 billion in direct and indirect costs. The disease spares no one. Primary prevention is clearly important, but for those in whom primary prevention has not been applied or has failed, acting to minimize the effect of a heart attack is of paramount importance. Many of its victims do not obtain appropriate medical care, or obtain it too late for the latest lifesaving technologies to be effective. The goal of treatment is to prevent death and to salvage as much heart tissue as possible. To achieve this goal, it is essential to minimize the time from the first symptoms and signs to treatment. Opportunities exist at each phase of an evolving AMI to intervene promptly and appropriately to prevent sudden death and to preserve cardiac muscle and thereby reduce CHD morbidity and mortality. Yet, formidable problems also exist. These and other issues are presently being studied by the National Heart, Lung, and Blood Institute staff and advisors in consideration of whether to establish a national educational program aimed at reducing CHD morbidity and mortality through the rapid identification and treatment of those with AMI.

Coronary Disease↗
PubMed2001

Patients' understandings of heart attack: implications for prevention of recurrence.

Patients' willingness to undertake secondary preventive strategies following heart attack are likely to be affected by their understandings of their condition. This qualitative study explored patients' understandings of heart attack in order to contribute to the design of effective secondary prevention services. In-depth interviews were conducted with 25 patients with myocardial infarction (MI). These data indicate that information received from health professionals encourages patients to view heart attack as an acute event rather than a symptom of a chronic condition and that this understanding provides patients with low motivation for long-term lifestyle change. Patients may benefit from understanding a heart attack as an acute symptom of an underlying disease process which long-term medication and behavioural change can help to check. In order to achieve this, health professionals need to examine patients' understandings of their heart attack and recovery and to provide information about lifestyle which engages with these understandings.

Acute Disease↗