What is the clinical evidence from this study?

Study design: Systematic Review. Population: Acute myocardial infarction and acute coronary syndrome (n=354497). Intervention: Cardiac patients vs. General population. Primary outcome: Weighted mean knowledge score for symptoms of acute myocardial infarction.

October 14, 2020Open Access

Cardiac symptom attribution and knowledge of the symptoms of acute myocardial infarction: a systematic review

BBBenedikt BirnbachMartin Luther University Halle-Wittenberg JHJens HöpnerMartin Luther University Halle-Wittenberg RMRafael MikolajczykLuther University

Key Result

Cardiac patients had a higher knowledge score for acute myocardial infarction symptoms (69.5%) than the general population (42.1%), but only 45.1% of patients attributed their symptoms to the heart.

Study Design

Type

Systematic Review (n=354,497)

Structured PICO

What is the level of knowledge of AMI symptoms and cardiac symptom attribution among the general population and cardiac patients?

Population

354,497 participants from 86 studies across 34 countries, including general population samples and cardiac patients (history of CAD or cardiac event), assessing knowledge of AMI symptoms and symptom attribution.

Outcome

Knowledge scores for the symptoms of AMI and the proportion of ACS patients correctly attributing their symptoms to a cardiac cause.patient reported

There is moderate to good knowledge of classic AMI symptoms but insufficient knowledge of atypical symptoms, and less than half of ACS patients correctly attribute their symptoms to a cardiac cause.

Main Result

Absolute Event Rate: 69.5% vs 42.1%

Limitations

Few studies from Africa, Russia, and South America, or from countries with a medium or low Human Development Index
Results might differ by the form of knowledge assessment chosen and the composition of the samples
Compared cardiac groups and population groups did not include the same set of countries
Inconsistencies among studies whether knowledge of some atypical symptoms contributed positively to the overall knowledge score

Abstract

BACKGROUND: Since the knowledge of the symptoms of acute myocardial infarction (AMI) may reduce the decision time for patients to seek help in case of an AMI, we aimed to summarize evidence on the knowledge of the AMI symptoms and the symptom attribution in case of an acute coronary syndrome (ACS). METHODS: Therefore, we systematically searched the databases PubMed, CINAHL, Embase, and Cochrane Library for relevant studies published between January 1, 2008 and 2019 (last search August 1, 2019). RESULTS: A total of 86 studies were included, with a composite sample size of 354,497 participants. The weighted mean of the knowledge scores for the symptoms of AMI of 14,420 participants from the general population, was 42.1% (when maximum score was considered 100%) and 69.5% for 7642 cardiac patients. There was a substantially better level of knowledge for six symptoms ('chest pain or discomfort', 'shortness of breath', 'pain or discomfort in arms or shoulders', 'feeling weak, lightheaded, or faint', 'pain or discomfort in the jaw, neck, or back', and 'sweating') (49.8-88.5%) compared to the four less obvious/atypical symptoms 'stomach or abdominal discomfort', 'nausea or vomiting', 'headache', and 'feeling of anxiety' (8.7-36.7%). Only 45.1% of 14,843 patients, who experienced ACS, have correctly attributed their symptoms to a cardiac cause. CONCLUSION: In conclusion, we found a moderate to good knowledge of "classic" and insufficient knowledge of less obvious symptoms of AMI. This might suggest that increasing knowledge about less obvious symptoms of AMI could be beneficial. It appears also important to address cardiac attribution of symptoms.

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