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Many With Heart Disease Don't Know Signs of Heart Attack

More than half don't see themselves at any increased risk, researchers find

TUESDAY, May 27 (HealthDay News) -- Almost half the patients with a history of heart disease are unfamiliar with the symptoms of a heart attack and don't see themselves being at increased risk for one, a new study finds.

The research flies in the face of the known facts about heart attack: People with heart disease face five to seven times the risk of having a heart attack or dying, compared with the general population. Survival depends on how quickly treatment begins, with your chances improving if that treatment starts within an hour after the symptoms begin. Yet most heart attack patients are generally admitted to hospital more than two hours after symptoms start.

"The most striking finding of this study is that about half of the patients who have had either a heart attack or invasive cardiac procedure still don't know the early warning signs for disease recurrence, even though they are at very high risk," said Dr. Byron Lee, an associate professor of cardiology at the University of California San Francisco, who was not involved in the study.

"It is hard to know who is at fault, doctors or patients," Lee added. "However, the bottom line is that we have to do a better job because lives are being lost."

The report is published in the May 26 issue of the Archives of Internal Medicine.

In the study, Kathleen Dracup, from the School of Nursing at the University of California, San Francisco, and colleagues collected data on 3,522 patients with a history of heart attack or an invasive cardiac procedure.

These patients were asked to identify the symptoms of a heart attack and respond to questions about heart disease. In addition, they were asked if they thought they were more or less likely than people their age to have a heart attack in the next five years.

Even though these people had a history of heart disease, 44 percent didn't know much about heart disease or their risk for heart attack. Women, people with higher education levels, those who had undergone cardiac rehabilitation, younger patients and those under the care of a cardiologist, rather than a family doctor, tended to know more, the researchers found.

While these people are at higher risk for heart attack, 43 percent said their risk was lower or the same as for other people their age. Among men, 47 percent thought they were at lower risk for a heart attack, as did 36 percent of women.

Dracup's group noted that emotional and cognitive factors play a part in whether patients seek immediate help for heart attacks.

Patients who do not know the symptoms of a heart attack, which can include nausea and pain in the jaw, chest or left arm, won't recognize the need for treatment. Moreover, patients with heart disease who don't see themselves as being at higher risk for heart attack, will look to other reasons for these symptoms, Dracup's team said.

Based on these findings, the team noted that heart patients need continued education about symptoms of heart attack and the benefits of early treatment and their increased risk.

"Our findings suggest that men, elderly individuals, those with low levels of education, and those who have not attended a cardiac rehabilitation program are more likely to require special efforts during medical office visits to review symptoms of acute myocardial infarction and to learn the appropriate actions to take in the face of new symptoms of acute coronary syndromes," the researchers concluded.

One expert thinks that doctors need to find ways to better educate patients about their risk for heart attack.

"This study suggests that health-care providers can do a much better job of providing continued education on risk status, cardiac symptoms, and the need for early assessment and treatment in patients with known ischemic heart disease," said Dr. Gregg C. Fonarow, the director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles.

"However, further study is needed to identify the most efficient and effective methods to provide this education and determine if better patient knowledge will translate into better quality of life and clinical outcomes," Fonarow added.

More information

For more information on heart attack, visit the American Heart Association.

SOURCES: Gregg C. Fonarow, M.D., director, Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles; Byron Lee, M.D., associate professor, cardiology, University of California San Francisco; May 26, 2008, Archives of Internal Medicine

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