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PubMedDate not supplied

Do older adults use the Internet for information on heart attacks? Results from a survey of seniors in King County, Washington.

BACKGROUND: Early treatment can reduce mortality from heart attacks. However, patient delay, especially among the elderly, has slowed progress in this area. One of the reasons for delay may be because of a lack of knowledge about symptoms of acute myocardial infarction (AMI) and treatment benefits. The Internet is a new and promising source of heart health information, but we know little about how elderly people use this medium. METHODS: This study investigates the demographic and psychosocial variables that are related to Internet access, health information seeking, and information seeking about heart attacks from the Internet among seniors. We interviewed seniors (N = 323) aged more than 65 years and asked them questions about Internet access, health information seeking, and information seeking on heart attacks, as well as demographic information, risk perceptions for AMI, and personal experience with AMI. RESULTS: The results showed that several demographic variables were related to access to the Internet. Only 7% of the seniors who reported access to the Internet had sought information on heart attacks from the Internet. Age, history of AMI, and family history of AMI were significant predictors of information seeking on heart attacks. This suggests that to date only a very small, high-risk group of seniors actually seeks information on heart attack emergencies from the Internet.

Age Factors↗
PubMed2003

Receipt of cardiac rehabilitation services among heart attack survivors--19 states and the District of Columbia, 2001.

Each year, approximately 650,000 persons have a first heart attack in the United States. Heart attack survivors are at increased risk for recurrent heart attacks, cardiovascular complications, and sudden cardiac death. A major component of risk-reduction strategies for these patients is cardiac rehabilitation consisting of nutritional counseling; management of lipid levels, hypertension, weight, and diabetes; smoking cessation; psychosocial interventions; and physical activity counseling and exercise training. Although cardiac rehabilitation has been associated with substantially improved survival rates, the majority of eligible patients do not participate in cardiac rehabilitation. This report summarizes data from the Behavioral Risk Factor Surveillance System (BRFSS) on the prevalence of self-reported participation in cardiac rehabilitation services among persons in 19 states and the District of Columbia (DC) who have had a heart attack. The findings indicate that less than one third of these respondents have participated in cardiac rehabilitation. Including cardiac rehabilitation in all intervention plans for eligible patients with coronary heart disease remains a key strategy for reducing further disability.

Behavioral Risk Factor Surveillance System↗
PubMed2002

Absence of risk factor change in young adults after family heart attack or stroke: the CARDIA Study.

BACKGROUND: Health behavior theories suggest that occurrence of heart attack or stroke in an immediate family member should increase one's perceived susceptibility to these conditions, which might lead to improved risk factor behavior and control. METHODS: Changes in measures of smoking, physical activity, lipids/lipoproteins, body weight, and blood pressure were investigated over two consecutive 5-year follow-up periods among 3950 participants (aged 18 to 30 years) in the Coronary Artery Risk Development in Young Adults (CARDIA) study, who either did or did not have an immediate family member experience a heart attack or stroke. Recruitment and examinations for Years 0, 5, and 10 took place in 1985-1986, 1990-1991, and 1995-1996, respectively. RESULTS: After adjustment for baseline demographics and risk factors, young adults who experienced a change in family history of heart attack or stroke over a 5-year period were no more likely than those who did not to quit smoking, or to experience more positive changes in weight, physical activity, LDL cholesterol, HDL cholesterol, triglycerides, or systolic or diastolic blood pressure. These findings persisted among the few study participants with one or more established risk factors at baseline. CONCLUSIONS: The occurrence of a heart attack or stroke in an immediate family member does not appear to lead to self-initiated, sustained change in modifiable risk factors in young adults. Since family history of heart attack and stroke is associated with known risk factors and is an independent risk factor for incident development of these conditions, interventions should be developed and tested to motivate sustained risk-factor control following occurrence of a severe vascular event in a family member.

Adult↗
PubMed2002

Knowledge of heart attack symptoms in a community survey of Victoria.

OBJECTIVE: To ascertain the level of knowledge of heart attack symptoms in the Victorian public. METHODS: This was a cross sectional telephone survey conducted during 2000-01. The questionnaire contained sections regarding participant demographics and knowledge of heart attack symptoms. RESULTS: A total of 1489 people completed the questionnaire (79% of eligible participants). The mean number of correct heart attack symptoms was 2.5 (95% CI 2.45, 2.60) (median three out of 10). Only 4.2% of participants reported at least five correct symptoms and 4.1% could not report any symptoms. A total of 84.6% of respondents reported chest pain as a symptom of heart attack. CONCLUSIONS: The Victorian public appears to lack the knowledge of the varied range of heart attack symptoms. Methods of disseminating information regarding symptoms and ways to reduce prehospital delay need to be devised, particularly methods which target the older 'at risk' population.

Adult↗
PubMed1998

Knowledge of heart attack symptoms in a population survey in the United States: The REACT Trial. Rapid Early Action for Coronary Treatment.

BACKGROUND: Greater use of thrombolysis for patients with myocardial infarction has been limited by patient delay in seeking care for heart attack symptoms. Deficiencies in knowledge of symptoms may contribute to delay and could be a target for intervention. We sought to characterize symptom knowledge. METHODS: Rapid Early Action for Coronary Treatment is a community trial designed to reduce this delay. At baseline, a random-digit dialed survey was conducted among 1294 adult respondents in the 20 study communities. Two open-ended questions were asked about heart attack symptom knowledge. RESULTS: Chest pain or discomfort was reported as a symptom by 89.7% of respondents and was thought to be the most important symptom by 56.6%. Knowledge of arm pain or numbness (67.3%), shortness of breath (50.8%), sweating (21.3%), and other heart attack symptoms was less common. The median number of correct symptoms reported was 3 (of 11). In a multivariable-adjusted model, significantly higher mean numbers of correct symptoms were reported by non-Hispanic whites than by other racial or ethnic groups, by middle-aged persons than by older and younger persons, by persons with higher socioeconomic status than by those with lower, and by persons with previous experience with heart attack than by those without. CONCLUSIONS: Knowledge of chest pain as an important heart attack symptom is high and relatively uniform; however, knowledge of the complex constellation of heart attack symptoms is deficient in the US population, especially in low socioeconomic and racial or ethnic minority groups. Efforts to reduce delay in seeking medical care among persons with heart attack symptoms should address these deficiencies in knowledge.

Adolescent↗
PubMed2005

Processes of cumulative adversity: childhood disadvantage and increased risk of heart attack across the life course.

OBJECTIVES: This article examines how processes of cumulative adversity shape heart attack risk trajectories across the life course. METHODS: Our sample includes 9,760 Health and Retirement Study respondents born between 1931 and 1941. Using self-reported retrospective measures of respondents' early background, we first identify three latent classes with differential exposure to childhood disadvantage. Intervening covariates associated with educational attainment, employment status, income attainment, marital history, and health behaviors are added to capture sequential processes of adversity. Final latent-class cluster models estimate the cumulative impact of these covariates on three different heart attack risk trajectories between 1992 and 2002: high, increasing, and low. RESULTS: Early disadvantage and childhood illness have severe enduring effects and increase the risk for heart attack. Adult pathways, however, differentially influence trajectories of heart attack risk and mediate the effects of early disadvantage. DISCUSSION: Findings suggest that future research should consider how processes of cumulative adversity initiated in childhood influence health outcomes in older ages.

Child↗
PubMed1998

The impact of education and heart attack on smoking cessation among middle-aged adults.

Considerable evidence supports the premise that higher levels of education lead to enhanced health, including protective health behaviors. This paper focuses on how education affects one health behavior known to lead to enhanced health: the cessation of smoking. In particular, the authors examine the extent to which education influences the decision by middle-aged adults to quit smoking following a heart attack, a potentially life-threatening health event. We first hypothesize that middle-aged adults with more formal education will stop smoking more readily than people with less formal education following the experience of a heart attack. Second, we ask what other factors might underlie and explain that hypothesized effect. Using longitudinal data, the authors track changes in individual smoking behaviors after a heart attack among preretirement-age Americans. We control for documented correlates of smoking and heart attack plus other factors associated with education, heart attack, and smoking that may also influence whether a person quits smoking. In addition to confirming evidence on the education-health association as well as the documented connection between heart attack and smoking cessation, this study provides a surprising twist on those links: Our results show that the move to quit smoking following the experience of a heart attack among middle-aged adults is significantly and dramatically moderated by their level of educational attainment.

Education↗
PubMed1984

Family history of heart attack as an independent predictor of death due to cardiovascular disease.

Although a family history of ischemic heart disease is a well-accepted risk factor for cardiovascular disease, only three prospective studies--all in men--have examined the predictive strength of a positive family history after adjusting for other heart disease risk factors. The present analysis is based on a 9 year follow-up of 4014 men and women from 40 to 79 years old who resided in Rancho Bernardo, CA, and who reported no known cardiovascular disease in response to a standardized interview. At baseline 38% of this group reported a family history of a heart attack in a parent, sibling, or child; 15% of those with a positive family history in a first-degree relative indicated that the heart attack had occurred before the relative was 50 years old. Younger men (less than 60 years) with a positive family history at any age had significantly higher mean blood pressures and total plasma cholesterol levels; older men were more likely to have diabetes mellitus. Younger women with a positive family heart attack to subsequent cardiovascular death was determined by the Cox model after adjusting for age, systolic blood pressure, total plasma cholesterol level, obesity, cigarette smoking, personal history of diabetes, and estrogen use (in women). In men, but not in women, a positive family history of heart attack was independently predictive of death from all causes and from cardiovascular and ischemic heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Weight change and risk of heart attack in middle-aged British men.

BACKGROUND: Both weight gain and weight loss have been associated with increased risk of cardiovascular disease mortality in recent studies from the US. This finding has led to concern and uncertainty about appropriate advice for overweight and obese subjects. METHODS: In a prospective study of cardiovascular disease, the relationship between weight change over a 5-year period and subsequent risk of a heart attack during a further 6.5 year follow-up was examined in 7100 middle-aged British men. RESULTS: Over half of the men remained stable (< 4% change in bodyweight) and served as the reference group; 31% gained weight and 13% lost weight. The 6445 men free from a history of coronary heart disease experienced 318 heart attacks, fatal and non-fatal, during the 6.5 years. Men who gained 4-10% bodyweight had the lowest rate of heart attack, although this was not significantly different from the stable group. The men who lost weight had an increased risk of heart attack, which after adjustment (for age, recall of doctor-diagnosed hypertension and diabetes and other coronary risk factors i.e. serum total cholesterol, blood pressure, social class, initial body mass index (BMI) and lung function (FEV1), and smoking status at screening and 5 years later), was of a similar level of risk to the stable group. The men who gained > 10% bodyweight had a significantly increased risk of a heart attack after the above adjustment (P < 0.05). When the effect of weight change was examined according to initial BMI, those men with a BMI < 25 kg/m2 who lost weight had a marginally increased relative risk of heart attack after full adjustment (P = 0.06), while men who were overweight (BMI 25-27.9 kg/m2) or obese (BMI > or = 28 kg/m2) showed no benefit from weight loss. A small amount of weight gain (4-10%) in the overweight or obese men was associated with decreased risk, whereas considerable weight gain (> 10%) was associated with increased risk, both findings reaching statistical significance in the overweight men (P < 0.05 and P < 0.001 respectively). CONCLUSIONS: Considerable weight gain (> 10%) in middle-aged men is associated with increased risk of a heart attack, but weight loss does not appear to reduce risk even in the overweight or obese.

Adult↗
PubMed1992

Role of renin secretion and kidney function in hypertension and attendant heart attack and stroke.

Control of blood pressure usually has not, by itself, affected the incidence of heart attack in hypertensive patients. This suggests a need for cause-specific therapy targeted against mechanisms that engage the risks of myocardial infarction. Study of the renin system, the ongoing, long-term servo-control over blood pressure and electrolyte homeostasis may provide answers. Inappropriately high renin production, generating the powerful vasoconstrictor, angiotensin II, may cause ischemic vascular damage in the heart, kidney and brain, predisposing to infarction. Many clinical situations associated with high plasma renin levels are accompanied by striking vascular damage, heart attack, or stroke. A recent prospective study of 1,717 hypertensive patients shows an unequivocally positive relationship between myocardial infarction and high-renin status regardless of other risk factors such as smoking, hypercholesteremia, or diabetes. The data also suggest the possibility that renin is a continuous variable, since the risk of heart attack was significantly weaker in medium-renin than in high and significantly greater than in low renin subjects. These observations are in keeping with concept that any renin secretion in the face of arterial hypertension is abnormal, since the truly normal kidney completely turns off its renin secretion. Thus the renin-sodium profile appears to be especially useful for evaluating the large fraction of patients who develop heart attacks in the absence of these other risk factors. Although, these findings suggest that a renin test should be performed routinely in hypertensive patients, the better to assess prognosis and design appropriate anti-renin therapy.

Blood Pressure↗
PubMed1989

Short stature, lung function and risk of a heart attack.

In a large prospective study of cardiovascular disease in 7735 middle-aged men--the British Regional Heart Study--the 443 subjects who experienced a major ischaemic heart disease event within 7.5 years of follow-up were on average 1.6 cm shorter than the other men (p less than 0.001). The risk of heart attack was approximately twice as great in the shortest quintile of men compared with the tallest quintile. When a number of recognized risk factors for ischaemic heart disease were taken into account--age, social class, serum total cholesterol, HDL-cholesterol, systolic blood pressure, cigarette smoking--there was a marked reduction in the risk of heart attack associated with height. When a measure of lung function (FEV1 not standardized for height) was adjusted for in addition to these risk factors, the height-related risk of heart attack disappeared. Indeed, FEV1 alone was sufficient to account for most of the association between height and the risk of heart attack.

Adult↗
PubMed2001

Accessing emergency care at the time of a heart attack: why people do not dial 999 for an ambulance.

Coronary heart disease (CHD) is the most important cause of death in the UK. Evidence suggests that between 5,000 and 10,000 deaths per year could be prevented if thrombolytic therapy were to be administered within 12 hours of the onset of symptoms of a heart attack. As part of the requirements of the National Service Framework for CHD, health authorities will be expected to produce detailed plans and protocols which describe pre-hospital service care models. Included in these will be public education campaigns aimed at encouraging people to call 999 for an ambulance in the event of symptoms suggestive of a heart attack. The aim of this study was to explore lay decision-making at the time of a cardiac event and address the question of why people do not call 999 for an ambulance. A sample of 43 patients, admitted to two district general hospitals who had survived a cardiac event, and 21 relatives or bystanders who were present at the time of the event, were interviewed. The interviews were tape-recorded, transcribed verbatim and analysed using the constant comparative method. There was variation in who made the decision to call for medical help and even after the decision was made, delays occurred due to interaction between patients and relatives or bystanders. An ambulance was called by informants in only two cases, two drove or were driven to hospital, 34 asked the general practitioner (GP) to call and five visited the GP at the surgery. Factors influencing these actions included a perception that GP services were faster and more accessible than ambulance services, misconceptions about the seriousness of the situation, misconceptions about the correct 'procedure' or way to access emergency services and a range of personal and contextual factors. The data suggest that public campaigns to encourage people to call 999 for an ambulance in the event of symptoms of a heart attack may be ineffective unless they address lay understandings and concerns about accessing emergency services.

Decision Making↗
PubMed1977

Work-energy level, personal characteristics, and fatal heart attack: a birth-cohort effect.

In a 22-year followup of 3686 San Francisco longshoremen, a cohort analysis assessed job activity and six personal characteristics in relation to 395 fatal heart attacks. Four cohorts aged 35-44, 45-54, 55-64, and 65-74 in 1951 were studied annually for job shifts affecting energy output and for sudden or delayed death from heart attack by age 75. All subjects underwent multiphasic screening for heavy cigarette smoking, higher blood pressure, history of prior heart disease, obesity, abnormal glucose metabolism, and higher blood cholesterol. The first three of these characteristics added risk of fatal heart attack. The amount of risk varied in the four cohorts. Higher energy output on the job reduced risk of fatal heart attack, especially sudden death, in the two younger cohorts, where less active workers were at threefold increased risk. Lack of this effect in the two older cohorts could imply real differences in their work habits, such as being less energetic in heavy jobs or more energetic in light jobs than the younger cohorts. Or, before the study began, early deaths may have winnowed susceptibles from the two older cohorts. Combined low-energy output, heavy smoking, and higher blood pressure increased risk by as much as 20-fold. By elimination of these adverse influences, this population might have had an 88% reduction in its rate of fatal heart attack during the 22 years.

Adult↗
PubMedDate not supplied

Bystanders of out-of-hospital sudden heart attack: knowledge and behaviors among older African Americans.

A community-based study of 425 older African Americans assessed whether their knowledge and behaviors were consistent with current recommendations regarding out-of-hospital sudden heart attack. More than 90% of the study participants were able to recognize major symptoms of sudden heart attack such as chest pain, shortness of breath, weakness, fatigue, fainting, and sweating, and, to a lesser extent, atypical pain, nausea, lightheadedness, and unexplained anxiety. When asked what they would do first in case they witness sudden heart attack, 97% responded that they would call emergency medical services. In contrast, of the participants who actually witnessed sudden heart attack, 80% called emergency medical services, whereas 20% waited to see if the symptoms would go away; called a neighbor, relative, or a friend before contacting emergency medical services; or took the victim to the hospital. These findings show that reported behavioral intentions were satisfactory, but actual bystanders' actions were not always consistent with current recommendations regarding sudden heart attack.

Black or African American↗
PubMed2000

Perceptions of multiple risk factors for heart attacks.

There is increasing evidence that in some diseases such as coronary heart disease, risk factors may interact synergistically, resulting in greater likelihood of disease than would be produced by the sum of the risk factors. These two studies aimed to examine the extent to which 210 undergraduate students and 28 heart attack patients perceive risk factors to combine synergistically. Respondents read one of four vignettes, describing information about risk factors (with high and low smoking and family history), and estimated a man's likelihood of a heart attack in a hypothetical case. In both studies an interaction was found with either a family history or smoking eliciting ratings of high likelihood of heart attack, providing no evidence of synergistic models. This finding may reflect respondents' beliefs or the insensitivity of this paper-and-pencil method in detecting synergistic effects.

Adult↗
PubMed1992

Management of myocardial infarction: implications for current policy derived from the Nottingham Heart Attack Register.

OBJECTIVE: A register of patients with heart attacks in the Nottingham Health District has been maintained since 1973. Data from 1982 to 1984 inclusive, a period before trials of thrombolytic therapy started in Nottingham, were analysed to provide background information for the introduction of a policy of routine thrombolysis for appropriate patients. DESIGN: Data were collected prospectively on all patients transported to hospital in the Nottingham Health District with suspected myocardial infarction in the years 1982-84 and on patients treated at home during that time. SETTING: Two district general hospitals responsible for all emergency admissions in the health district. PATIENTS: 6712 patients admitted to hospital with suspected myocardial infarction and 1887 patients found dead on arrival at hospital. Approximately 1500 patients in whom a myocardial infarction was suspected were treated at home, but only 125 were identified who had a definite or probable infarction. RESULTS: Among the patients admitted within 24 hours of the onset of symptoms, the median delay from onset to hospital admission was 174 minutes; 25% of patients were admitted within 91 minutes. The only factor that seemed to affect the time taken was the patient's decision to call a general practitioner or an emergency ambulance. If a general practitioner referred the patient to hospital the median delay was 247 minutes, compared with 100 minutes when the patient summoned an ambulance. Ninety three per cent of all patients were transported by ambulance. The median time from the call for the ambulance to hospital arrival was 29 minutes. Once a patient was admitted to hospital, the time to admission and general practitioner involvement seemed relatively unimportant as predictors of outcome. Patients admitted more than nine hours after onset of symptoms with a diagnosis of definite or probable infarction had a poorer outcome than those admitted earlier (in-hospital mortality 22.4% v 13.1%). The fatality rates of those admitted to a coronary care unit or to an ordinary medical ward are similar. CONCLUSION: Although the introduction of thrombolytic therapy has brought with it an increased awareness of the need to minimise any delay in time to admission, it seems that in a predominantly urban area like Nottingham, patients with a suspected heart attack will continue to be admitted to hospital most quickly if an ambulance crew rather than a general practitioner is called. Because the ambulance crew was in contact with such patients for only a short time it seems unlikely that administration of a thrombolytic drug in the ambulance would be helpful.

Coronary Care Units↗
PubMed1990

The structure of readjustment after heart attack.

A comprehensive multivariate framework aimed at predicting the factors that enhance or impede readjustment after a heart attack, has been developed and empirically supported by a study among convalescents after heart attack. Application of multivariate techniques of data analysis revealed a 'structure' highlighting the relative weight of various 'demands' in impeding readjustment, and the relative significance of the individual's self-controlled resources in coping with these demands and thus enhance readjustment. The data further show the crucial role of the spouse in both enhancing resources and furthering readjustment. By distinguishing between three dimensions of readjustment--the affective, the instrumental, and the cognitive--the data further the understanding of the differential effects of various demands, resources, and spouse support on readjustment. The herein theoretically justified and empirically supported structure expands the earlier developed structure of readjustment of traumatically irreversible disabled persons, taking into consideration the peculiar situation of the convalescents after heart attack, the trilateral conceptualization of readjustment.

Adaptation, Psychological↗
PubMed1987

One thousand heart attacks in Grampian: the place of cardiopulmonary resuscitation in general practice.

The outcome of 1011 heart attacks in patients under the care of general practitioners who practised cardiopulmonary resuscitation and were equipped with defibrillators is reported. The 28 day mortality was 36% (367 patients), and 59% of deaths occurred outside hospital. The general practitioner was the first medical contact in 92% of heart attacks and was equipped with a defibrillator in 80% of such calls. Fifty six patients had a cardiac arrest in the presence of a general practitioner, and resuscitation was attempted in 47 cases, representing 5% of all calls for heart attacks. Twenty one (45%) resuscitated patients reached hospital alive, and 13 (28%) survived to leave hospital. The opportunities for cardiopulmonary resuscitation in general practice occur sufficiently often to warrant training and equipping general practitioners for advanced life support. The results of resuscitation by general practitioners working alone compare favourably with those of mobile coronary care units based in hospitals.

Family Practice↗