Patients' knowledge of risk and protective factors for cardiovascular disease

Comparing Gerd and Non-GERD Patients Regarding Knowledge Level of Acute Myocardial Infarction Symptoms, Risk Factors and Immediate Action Must Be Taken in Eastern Province, Saudi Arabia

INTRODUCTION

A major cause of death globally is cardiovascular disease (CVD). Chest pain, nausea, vomiting, and heartburn are common symptoms of acute myocardial infarction (AMI). Chest pain is also the main symptom of gastroesophageal reflux disease (GERD). Therefore, the differential diagnosis of chest pain can become more challenging when GERD and AMI coincide. This study evaluated and compared the knowledge of the signs, symptoms, and immediate action that must be taken regarding AMI among GERD and non-GERD patients.

METHODOLOGY

An observational cross-sectional study using an online questionnaire was created and published between October and November 2022 to collect data from Saudi males and females 18 or older willing to participate in the study. Participants who were not Saudi had declined to complete the survey or had not fully completed it was excluded. The questionnaire contained three sections; after collecting informed consent, it made inquiries regarding respondents' GERD status, demographic information, and knowledge and attitudes regarding GERD.

RESULTS

This study included 691 responses from 300 non-GERD participants and 391 GERD participants. The study showed a high level of awareness (75.5%) of GERD, with significant differences in the level of awareness according to marital status, education levels, and occupation status. There was no significant difference in the level of awareness according to gender and GERD diagnosis, where the p-value > 0.05. The most common source of information about AMI was the Internet, followed by health care professionals. The most commonly known symptoms of AMI were sudden pain or discomfort in the chest, followed by a sudden shortness of breath. Additionally, there was no significant association between the diagnosis of GERD and known risk factors. The association between GERD and other diseases (chi-square = 46.94, p-value 0.01). Obesity and smoking were the two main risk factors for heart attacks.

CONCLUSION

This study demonstrated that there was no significant difference between GERD and non-GERD participants regarding the knowledge and awareness level of AMI. Moreover, it showed that there was a lack of general knowledge and awareness of AMI in Saudi Arabia. The authors recommend initiating more awareness programs in Saudi Arabia to inform people about AMI and cardiovascular disease. More research is required to determine whether other patients are aware of AMI.

Perceived Risk of Heart Attack and Type 2 Diabetes in Hispanic Adults With Overweight and Obesity

BACKGROUND

Individuals with a greater perceived risk of heart attack or type 2 diabetes tend to adopt recommended lifestyle changes to minimize their risks. Despite the rapidly growing Hispanic population in the United States, data regarding their perceived risks are lacking.

OBJECTIVE

This study aimed to examine the perceived risk of suffering a heart attack and/or developing type 2 diabetes and to explore the factors associated with these risk perceptions in Hispanic adults with overweight/obesity.

METHODS

We analyzed 69 Hispanic adults with overweight/obesity who participated in the screening/baseline visit for the Adelgaza study, a weight loss and diabetes prevention trial, using descriptive statistics and logistic regressions. Heart attack or type 2 diabetes risk perception was assessed using a single-item questionnaire.

RESULTS

The mean (SD) values for age and body mass index (BMI) were 43.8 (11.2) years and 31.7 (4.5) kg/m 2 , respectively. Of all participants, 46.4% perceived a low risk for heart attack and 29.0% perceived a low risk for developing type 2 diabetes in their lifetime, whereas only 11.6% reported both risk perceptions. Older age, lower BMI, and longer walking duration (minutes) per day were significantly associated with a lower perceived risk of heart attack ( P < .05). Having no family history of heart attack, lower BMI, and lower fat intake were significant predictors of a lower diabetes-risk perception ( P < .05).

CONCLUSIONS

Hispanic adults with overweight/obesity seem to underestimate their risks of heart attack and type 2 diabetes.

Public awareness of early symptoms of acute myocardial infarction among Saudi population

Introduction:

Globally speaking, cardiovascular disease is the leading cause of mortality, with coronary artery disease (CAD) contributing to half of the cases. A major complication of CAD is myocardial infarction (MI). The clinical outcomes of MI are predominantly time-dependent; therefore, it is paramount that the general public is familiar with the early symptoms of MI.

Aim:

The main objective is to gauge the local public awareness of the early symptoms of MI, and their knowledge of the best course of action to be taken from the onset of symptoms.

Method:

A cross-sectional study was conducted using google forms. Participants were randomly selected through multiple social media platforms. The study included Saudi citizens who were 18 years or older, with no current or prior experience in the health care field. The questionnaire assessed the participants' awareness of 14 risk factors for CAD. The variables investigated were participants' knowledge of the symptoms, causes, appropriate course of action to be taken, and the risk factors of CAD.

Results:

A total of 1689 participants were involved in this study. Sixty percent were females, and 29.2% were in the age group of 18–24 years. Seventy-three percent of the participants knew the definition of heart attack, and 90% knew that chest pain is a symptom of a heart attack. Approximately, 75% of the participants recognized that hypertension, cigarette smoking, and high cholesterol are the risk factors of MI. In terms of knowledge, Al Madinah province obtained the highest score when compared with other regions.

Conclusion:

This study showed the overall knowledge and awareness of CAD was suboptimal, indicating that awareness initiatives and patient education of CAD need more work in Saudi Arabia, especially in high-risk groups and lower education groups. More studies are needed to identify the efficiency and population access of different approaches for CAD awareness.

Knowledge and cardiovascular disease risk perception from the perspectives of prisoners and staff in a Scottish prison: a qualitative study

PURPOSE

Prisoners have an increased risk of cardiovascular disease (CVD) compared to the general population. Knowledge and risk perception of CVD can influence engagement in preventative behaviours that lower an individual's CVD risk. This paper aims to explore prisoners' knowledge of CVD, and prisoners and staff's perceptions of prisoners' CVD risk.

DESIGN/METHODOLOGY/APPROACH

This was a qualitative study in which semi-structured interviews were conducted with 16 prisoners and 11 prison and National Health Services staff in a Scottish prison. Data were analysed thematically using the framework method.

FINDINGS

Most prisoners had limited knowledge of CVD as they could not describe it or could only identify one or two risk factors or cardiovascular events. Both prisoners and staff viewed prisoners' CVD risk as either pertaining to one individual, or pertaining to the general prisoner population. Unhealthy behaviours that were believed to increase CVD risk were linked to three perceived consequences of imprisonment: mental health problems, boredom and powerlessness.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this is the first study to explore the CVD knowledge of prisoners, and perceptions of CVD risk from the perspectives of prisoners and prison staff. Findings from this study indicate that CVD education needs to be a priority for prisoners, addressing knowledge of CVD, its risk and risk perceptions. Additionally, the findings indicate that individual and socio-environmental factors linked to prisoners' CVD risk need to be targeted to reduce this risk. Future research should focus on socio-environmental interventions that can lead to reducing the CVD risk of prisoners.

A Community-Based, Cross-Sectional Study Assessing the Level of Awareness and Insight Related to Cardiovascular Diseases

Objective

The disease outcome had been shown to improve with improving patient knowledge. The study had two objectives, firstly to assess the level of knowledge about cardiovascular diseases (CVDs) in the general population, and secondly, to provide written educational material regarding the risk factors, major symptoms, and the prevention of CVDs.

Method

The target population was the residents living in the Western region of Saudi Arabia, aged 18 years and above. All were invited to participate voluntarily. A pre-structured questionnaire was designed to collect data related to age, gender, marital status, education level, occupation, lifestyle habits, and a history of heart diseases, as well as cardiac symptoms, and risk factors. The educational material was provided after the questionnaire.

Results

The majority of the participants were female (74.8%). The risk factors most frequently identified were lack of exercise, stress, and obesity. Chest pain was recognized as a major symptom (87.6%). Other symptoms included dyspnea, syncope, and excessive sweating. The level of knowledge regarding the risk factors for cardiovascular disease was poor. Only 18.5% were knowledgeable about the risk factors. The majority (60%) could identify the preventable factors, including smoking cessation (92.2%), a high level of cholesterol (88.6%), and hypertension (78.7%). The majority (83.7%) read the educational material and 99% reported that the lecture increased their knowledge about cardiovascular disease.

Conclusion

Although cardiovascular risk factors are common, there is a big gap in the knowledge in our population. Further, alarming symptoms that bring the patients to medical care are also deficient. A call for action at different levels is urgent. Simple educational material in a basic language and virtual education are useful and cheap tools that must be practiced wherever possible. Education is welcomed by the participants.

Effects of an empowerment-based intervention on health-related knowledge and resilience in patients with coronary artery stent implantation

OBJECTIVES

To examine the effects of an empowerment-based intervention on health-related knowledge and resilience among patients after coronary artery stent implantation.

METHODS

This was a randomized controlled trial with a 4-week-long intervention. Participants were randomly allocated to an empowerment-based intervention group (n = 42) or control group (n = 43). Knowledge on CHD and resilience were evaluated and compared between groups.

RESULTS

Compared with the control group, patients in the intervention group showed higher score changes for CHD total knowledge (U = 196.500; P ＜ 0.001) and its 5 dimensions including CHD definition (U = 657.500; P = 0.022), manifestation (U = 245.000; P ＜ 0.001), examination (U = 639.000; P = 0.015), treatment (U = 475.000; P ＜ 0.001), and medication (U = 465.000; P ＜ 0.001), and higher level of resilience (t = 3.235; P = 0.002).

CONCLUSION

The empowerment-based intervention was effective in enhancing the knowledge on CHD and improving resilience for patients with coronary artery stent implantation.

PRACTICE IMPLICATIONS

The structured empowerment-based intervention provides a basis for facilitating the use of this intervention in patients with coronary heart disease.

Recognizing a Heart Attack: Patients' Knowledge of Cardiovascular Risk Factors and Its Relation to Prehospital Decision Delay in Acute Coronary Syndrome

In acute coronary syndromes (ACSs), longer decision delay - the time patients wait before seeking medical attention after symptoms have started - increases the risk of complications and death. However, many patients wait much longer than recommended and research is needed investigating how patient decision delay can be reduced. In a cross-sectional study of 120 ACS survivors, we investigated the relationship between knowledge of cardiovascular risk factors and decision delay. Several days after the onset of a cardiac event, patients completed a questionnaire measuring demographics, decision delay, objective knowledge of cardiovascular risks factors and of ACS symptoms, and subjective perceptions of symptoms during the cardiac episode. Relevant clinical data were extracted from patients' medical records. In a multiple linear regression analysis, controlling for demographic and clinical factors, objective knowledge of cardiovascular risk factors and ACS symptoms, and subjective attributions of symptoms to a cardiac cause were related to shorter decision delays. Among patients with relatively high knowledge of risk factors, only 5% waited more than 1 h to seek help, compared to 22% among patients with relatively low knowledge. These results suggest that knowledge of the factors that increase the risk of developing cardiovascular disease could play a role in patient decision making during an acute cardiac event. We discuss methodological issues and potential underlying mechanisms related to decision heuristics and biases, which can inform future research.

Patient Perspectives on Smoking Cessation and Interventions in Rheumatology Clinics

OBJECTIVE

Although smoking is a risk factor for cardiovascular and rheumatic disease severity, only 10% of rheumatology visits document cessation counseling. After implementing a rheumatology clinic protocol that increased tobacco quitline referrals 20-fold, we undertook this study to examine patients' barriers and facilitators to smoking cessation based on prior rheumatology experiences, to solicit reactions to the new cessation protocol, and to identify patient-centered outcomes or signs of cessation progress following improved care.

METHODS

We recruited 19 patients who smoke (12 with rheumatoid arthritis [RA] and 7 with systemic lupus erythematosus [SLE]) to participate in 1 of 3 semistructured focus groups. Transcripts of the focus group discussions were analyzed using thematic analysis to classify barriers, facilitators, and signs of cessation progress.

RESULTS

Participant-reported barriers and facilitators to cessation involved psychological, health-related, and social and economic factors, as well as health care messaging and resources. Commonly discussed barriers included viewing smoking as a crutch amid rheumatic disease, rarely receiving cessation counseling in rheumatology clinics, and very limited awareness that smoking can worsen rheumatic diseases or reduce efficacy of some rheumatic disease medications. Participants endorsed our cessation protocol with rheumatology-specific education and accessible resources, such as a quitline. Beyond quitting, participants prioritized knowing why and how to quit as signs of progress outcomes.

CONCLUSION

Focus groups identified themes and categories of facilitators/barriers to smoking cessation at the levels of patient and health system. Two key outcomes of improving cessation care for patients with RA and SLE were knowing why and how to quit. Emphasizing rheumatologic health benefits and cessation resources is essential when designing and evaluating rheumatology smoking cessation interventions.

Life's simple 7 and cardiovascular disease risk knowledge in Hong Kong

BACKGROUND

This study aimed at investigating the CV health and CV disease knowledge in terms of LS7 score among 3 age groups in Hong Kong.

METHODS

A cross-sectional multicenter observational study was conducted to observe the CV health and disease risk knowledge in Hong Kong. Elderly subjects were recruited from 15 elderly centers, whereas young adults and the middle-aged were recruited from 6 on-campus health check sessions. Subjects' demographics, lifestyle behavior and risk knowledge were obtained through questionnaire while their body mass index, random capillary blood glucose, blood cholesterol and blood pressure were measured. LS7 score and risk knowledge score was calculated.

RESULTS

The LS7 of younger adult, middle-aged and elderly were 10.6 ± 1.3, 9.3 ± 1.9 and 9.7 ± 1.7 respectively. Only 0.6% participants have attained ideal CV health and 35.9% have 5 to 7 ideal CV health metrics. Elderly performed worst in risk knowledge with a score of 8.1 ± 3.3 while young adult and middle-aged were similar (9.6 ± 1.8 and 9.7 ± 1.5). 71% of the participants correctly identified ≥9 components. Logistic regression revealed that subjects aged ≤65 years (OR 2.341, 95% CI 1.779 to 3.080) and with tertiary education (OR 2.031, 95% CI 1.527 to 2.701) were more likely to obtain optimum LS7. No association was found between having optimum LS7 and full knowledge.

CONCLUSION

Only few adults in this study population had ideal CV health as defined by AHA. Knowledge has no association but young age and tertiary education has positive association with CV health.

Physicians' lifestyle advice on primary and secondary cardiovascular disease prevention in Germany: A comparison between the STAAB cohort study and the German subset of EUROASPIRE IV

Background

We assessed prevalence and determinants in appropriate physician-led lifestyle advice (PLA) in a population-based sample of individuals without cardiovascular disease (CVD) compared with a sample of CVD patients.

Methods

PLA was assessed via questionnaire in a subsample of the population-based Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort free of CVD (primary prevention sample) and the German subset of the fourth EUROASPIRE survey (EUROASPIRE-IV) comprising CVD patients (secondary prevention sample). PLA was fulfilled if the participant reported having ever been told by a physician to: stop smoking (current/former smokers), reduce weight (overweight/obese participants), increase physical activity (physically inactive participants) or keep to a healthy diet (all participants). Factors associated with receiving at least 50% of the PLA were identified using logistic regression.

Results

Information on PLA was available in 665 STAAB participants (55 ± 11; 55% females) and in 536 EUROASPIRE-IV patients (67 ± 9; 18% females). Except for smoking, appropriate PLA was more frequently given in the secondary compared with the primary prevention sample. Determinants associated with appropriate PLA in primary prevention were: diabetes mellitus (odds ratio (OR) 4.54; 95% confidence interval (CI) 1.88–10.95), hyperlipidaemia (OR 3.12; 95% CI 2.06–4.73) and hypertension (OR 1.74; 95% CI 1.15–2.62); in secondary prevention: age (OR per year 0.96; 95% CI 0.93–0.98) and diabetes mellitus (OR 2.33; 95% CI 1.20–4.54).

Conclusions

In primary prevention, PLA was mainly determined by the presence of vascular risk factors, whereas in secondary prevention the level of PLA was higher in general, but the association between CVD risk factors and PLA was less pronounced.

Population awareness of coronary artery disease risk factors in Jeddah, Saudi Arabia: a cross-sectional study

BACKGROUND

Coronary artery disease (CAD) is a serious cardiovascular disorder affecting middle-aged individuals. It is a major cause of death among adults over the age of 35 years. In Saudi Arabia, CAD is associated with higher mortality rate, and Saudi patients are reported to have significantly higher prevalence of risk factors for CAD than the Western population. Furthermore, as, to date, there is no definite cure for CAD, prevention of the disease and tight control of the known risk factors are the cornerstones for reducing CAD-associated mortality. Thus, the present work aimed to assess the population awareness of CAD risk factors in Saudi Arabia.

METHODS

A cross-sectional study was conducted in Jeddah during the period January 2017 to December 2017 by using an online survey questionnaire to assess participants' awareness of 14 risk factors for CAD, namely: smoking, lack of physical activity, fast food and soft drink intake, television and computer use; history of diabetes mellitus, myocardial infarction and stroke; as well as a family history of diabetes mellitus, diabetes, hypertension, hyperlipidemia, CAD and myocardial infarction.

RESULTS

Of 468 respondents, 41% were males. The mean age was 31.9±12.4. Approximately 86% were Saudi, and ~60% had a university education. The mean overall awareness score was 4.31±1.36 (1.00-8.00). Fast food, soft drinks, and family history of diabetes were the most commonly identified risk factors, reported by 74.8%, 64.3%, and 47.2% of participants, respectively. There was a strong correlation between overall awareness score and awareness of each risk factor individually (P<0.003).

CONCLUSION

There is an evident limited knowledge among the population in Jeddah, Saudi Arabia regarding the risk factors for CAD, and it is recommended that the healthcare sector in the country focus on public health education programs about the disease.

Metabolic Syndrome Knowledge among Adults with Cardiometabolic Risk Factors: A Cross-Sectional Study

Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors. Many people may be unaware of their risk for MetS. A cross-sectional, descriptive study was conducted among hospitalized patients with at least one cardiometabolic risk factor in Mainland China. This study assessed the MetS knowledgelevel(through MetS Knowledge Scale, MSKS) and examined the potential predictors by regression analysis. A total of 204 patients aged 58.5 ± 10.1 years (55% males) participated in this study. The majority of participants had no history of hypertension (54%), dyslipidemia (79%), or diabetes (85%). However, 56% of these participants had at least three cardiometabolic risk factors, indicating the presence of MetS. The average MSKS was very low (mean = 36.7 ± 18.8, possible range = 0–100), indicating the urgent needs of MetS education in current practice. Predictors of better MetS knowledge included higher educational level, history of dyslipidemia, and normal high-density lipoprotein cholesterol (F (8, 195) = 9.39, adjusted R² = 0.192, p < 0.001). In conclusion, adults with cardiometabolic risk factors are at risk of developing MetS, but with a low level of knowledge. Specific health education on MetS should be provided, particularly for those with limited formal education or inadequate lipid management.

Risk Knowledge and Awareness of Coronary Heart Disease, and Health Promotion Behaviors Among Adults in Oman

Background and Purpose:

The purpose of this study was to assess the relationships between an individual’s characteristics and experiences (age, gender, level of education, income, and employment), knowledge of coronary heart disease (CHD) risk factors, perception of health status, awareness of CHD, and health promotion behaviors among adult Omanis.

Methods:

Using Pender’s health promotion model, a cross-sectional and correlational survey design was employed. A self-administered questionnaire was distributed to 180 participants in Muscat, the capital of Oman. Descriptive and multivariate linear regression analyses were employed.

Results:

Increasing age was associated with high levels of awareness about CHD. Participants who were employed and knowledgeable about CHD risk factors were more likely to have lower perceptions of health. The regression model showed that knowledge of CHD risk factors and awareness of CHD had positive associations with health promotion behaviors. Meanwhile, employed participants had lower health promotion behaviors scores.

Implications for Practice:

Interventions to increase health promotion behaviors should include application of behavioral change strategies that are suitable for age and employment status. The strategies must focus on providing information to enhance knowledge and awareness about CHD.

Persistence of socioeconomic inequalities in the knowledge of cardiovascular risk factors five years after coronary angiography

BACKGROUND

Cardiovascular diseases are important causes of death, morbidity, and years of potential life lost in most developed countries.

AIMS

The purpose of this study was to assess trends in knowledge of cardiovascular risk factors among patients five years after coronary angiography and to investigate the impact of educational level on knowledge level.

METHODS

The study included 1289 of 4391 patients admitted for cardiac events in 2008/2009 at the National Institute for Cardiac Surgery and Interventional Cardiology, Luxembourg. A follow-up study was conducted by post five years later (2013/2014). Data were obtained from 1837 of the contacted patients (with 548 reported deaths) (response rate=42%). Logistic regression models were used to evaluate the association between educational level and knowledge of cardiovascular risk factors. Educational level was used as a surrogate for socioeconomic status.

RESULTS

In total, 39.9% of patients could list at least three risk factors in 2013/2014, a much higher percentage than the 8.5% observed during the initial survey. In both sexes, knowledge of cardiovascular risk factors increased between 2008/2009 and 2013/2014. Patients with higher educational levels were more likely (odds ratio=2.33, 95% confidence interval: 1.63-3.34) to cite at least three risk factors than patients with lower education levels.

CONCLUSION

Knowledge level was associated with educational level, and improved for all educational groups five years after coronary angiography. Educational differences in knowledge persisted, but the gaps decreased. Improving knowledge of cardiovascular risk factors among patients with cardiovascular disease will help increase awareness and promote lifestyle changes.

Effect of a health literacy intervention trial on knowledge about cardiovascular disease medications among Indigenous peoples in Australia, Canada and New Zealand

OBJECTIVES

To assess the effect of a customised, structured cardiovascular disease (CVD) medication health literacy programme on medication knowledge among Indigenous people with, or at high risk of, CVD.

DESIGN

Intervention trial with premeasures and postmeasures at multiple time points.

SETTING

Indigenous primary care services in Australia, Canada and New Zealand.

PARTICIPANTS

171 Indigenous people aged ≥20 years of age who had at least one clinical diagnosis of a CVD event, or in Canada and Australia had a 5-year CVD risk ≥15%, and were prescribed at least two of the following CVD medication classes: statin, aspirin, ACE inhibitors and beta blockers.

INTERVENTION

An education session delivered on three occasions over 1 month by registered nurses or health educators who had received training in health literacy and principles of adult education. An interactive tablet application was used during each session and an information booklet and pill card provided to participants.

PRIMARY OUTCOME MEASURES

Knowledge about the CVD medications assessed before and after each session.

RESULTS

Knowledge at baseline (presession 1) was low, with the mean per cent correct answers highest for statins (34.0% correct answers), 29.4% for aspirin, 26.0% for beta blockers and 22.7% for ACE inhibitors. Adjusted analyses showed highly significant (P<0.001) increases in knowledge scores between preassessments and postassessments at all three time points for all medication classes. For the four medications, the absolute increases in adjusted per cent correct items from presession 1 to postsession 3 assessments were 60.1% for statins, 76.8% for aspirin, 71.4% for ACE inhibitor and 69.5% for beta blocker.

CONCLUSIONS

The intervention was highly effective in contextually diverse Indigenous primary healthcare services in Australia, Canada and New Zealand. The findings from this study have important implications for health services working with populations with low health literacy more generally.

TRIAL REGISTRATION NUMBER

ACTRN12612001309875.

Knowledge of warning signs, presenting symptoms and risk factors of coronary heart disease among the population of Dubai and Northern Emirates in UAE: a cross-sectional study

BACKGROUND

To evaluate the level of knowledge regarding warning signs, presenting symptoms and risk factors associated with coronary heart disease (CHD) among population of Dubai and Northern Emirates in UAE.

MATERIALS AND METHODS

A cross sectional survey of 1367 residents of Dubai and Northern Emirates was conducted using a self-administered questionnaire.

RESULTS

Respondents were classified into two groups: Young Adult Population (YAP; 18-24 years of age) and General Population (GP; 25 years and older). Majority of participants were males (56.7%) and of South Asian (57.5%) or Middle-Eastern (30.8%) ethnicity. Regarding presenting symptoms of CHD, chest pain was identified by around 80% of population, whereas pain in the left shoulder was recognized by 61% of GP and 44% of YAP. Atypical symptoms were poorly identified. Regarding risk factors, only one-fourth population knew that males were at higher risk compared to premenopausal females. Few knew that the risk increases in females after menopause and that the risk is higher for females who smoke and use oral contraceptives. 62% knew that the survivors of a heart attack are at high risk of recurrences. Except for tobacco smoke, hypercholesterolemia and hypertension, knowledge of other risk factors was not satisfactory. Older adults and females had comparatively higher level of knowledge.

CONCLUSION

Knowledge level of many of the symptoms and risk factors of CHD is unsatisfactory. There is, therefore, a need to increase the awareness in the population of UAE. The knowledge gaps identified through this study can be addressed through health campaigns to increase the awareness about warning signs, symptoms and modifiable risk factors. .

Cardiovascular risk factors among college students: Knowledge, perception, and risk assessment

OBJECTIVE

To assess college students' knowledge and perception of cardiovascular risk factors and to screen for their cardiovascular risks.

PARTICIPANTS

The final sample that responded to recruitment consisted of 158 college students from a midwestern university.

METHODS

A cross-sectional, descriptive study was performed using convenience sampling.

RESULTS

College students were knowledgeable about cardiovascular risk factors but did not perceive themselves at risk for cardiovascular disease (CVD). Knowledge of cardiovascular risk factors was correlated with the lifetime risk estimates (ρ = .17, p = .048), and perception of cardiovascular risk was positively associated with 30-year CVD risk estimates (ρ = .16, p = .048). More than 50% of the participants had 1 or more cardiovascular risk factors.

CONCLUSIONS

High knowledge level of cardiovascular risk factors was not sufficient to lower cardiovascular risks within this study population, but changing perception of cardiovascular risk factors may play a bigger role in reducing long-term cardiovascular risks.

Patient, Physician, and Practice Characteristics Associated with Cardiovascular Disease Preventive Care for Women

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death for American women. Although CVD preventive care has the potential to reduce a significant number of these deaths, the degree to which healthcare providers deliver such care is unknown. The purpose of this study was to identify patient, physician, and practice characteristics that significantly influence the provision of CVD preventive care during ambulatory care visits for female patients.

METHODS

The National Ambulatory Medical Care Survey datasets from 2005 to 2010 were utilized. The study sample included female patients ≥20 years of age whose healthcare provider performed CVD preventive care and who had visits for a new health problem, a routine chronic problem, management of a chronic condition, and preventive care. Binary logistic regression models estimated the association of patient, physician, and practice characteristics and CVD preventive care; cholesterol testing, body mass index (BMI) screening, and tobacco education.

RESULTS

Of the 32,009 visits, 15.9% involved cholesterol testing, 50.3% involved BMI screening, and 3.20% involved tobacco education. Obstetricians/gynecologists were less likely to perform cholesterol testing (aOR: 0.39; 95% CI: 0.25-0.61) and tobacco education (aOR: 0.56; 95% CI: 0.32-0.98) than general/family physicians.

CONCLUSION

The delivery of CVD preventive care varied by healthcare provider type, with obstetricians/gynecologists having lower odds of providing two of the three services. The amount of time a physician spent with a patient was a significant predictor for the provision of all three services. These findings demonstrate the need to implement multifaceted approaches to address predicting characteristics of CVD preventive care.

Racial/Ethnic Differences in Knowledge of Personal and Target Levels of Cardiovascular Health Indicators

This study aimed to examine ethnic differences in knowledge of personal and target levels of cardiovascular health indicators between non-Hispanic whites and African Americans. A secondary objective was to evaluate the associations between knowledge of cardiovascular health indicators and health promotion behaviors. Participants (66.7% female) consisted of 265 whites and 428 African Americans, ages 18 and older recruited from primary care clinics and churches. Respondents completed a brief survey on blood pressure (BP), total cholesterol, blood glucose, body mass index (BMI), diet, and physical activity. Whites were more likely than African Americans to report knowing their personal and target levels of cardiovascular health indicators. Knowledge of personal BP and/or BMI was positively associated with actual physical activity, and awareness of personal blood glucose was positively associated with healthy dietary practices for participants in both groups. Among whites, awareness of personal BP and knowledge of target levels for BP, total cholesterol, and BMI were also associated with healthy diet. Results suggest there are racial/ethnic disparities in knowledge of personal and ideal levels of cardiovascular health indicators, and that this knowledge is related to health promotion behaviors. Targeted educational efforts are warranted to enhance knowledge of personal risk indicators among African Americans.

Fostering African-American Improvement in Total Health (FAITH!): An Application of the American Heart Association's Life's Simple 7™ among Midwestern African-Americans

OBJECTIVE

African-Americans have a strikingly low prevalence of ideal cardiovascular health metrics of the American Heart Association's Life's Simple 7 (LS7). This study was conducted to assess the impact of a community-based cardiovascular disease prevention intervention on the knowledge and achievement of cardiovascular health metrics among a marginalized African-American community.

METHODS

Adult congregants (n = 37, 70 % women) from three African-American churches in Rochester, MN, participated in the Fostering African-American Improvement in Total Health (FAITH!) program, a theory-based, culturally-tailored, 16-week education series incorporating the American Heart Association's LS7 framework. Feasibility testing included assessments of participant recruitment, program attendance, and retention. We classified participants according to definitions of ideal, intermediate, and poor cardiovascular health based on cardiac risk factors and health behaviors and calculated an LS7 score (range 0 to 14) at baseline and post-intervention. Knowledge of cardiac risk factors was assessed by questionnaire. Main outcome measures were changes in cardiovascular health knowledge and cardiovascular health components related to LS7 from baseline to post-intervention. Psychosocial measures included socioeconomic status, outlook on life, self-reported health, self-efficacy, and family support.

RESULTS

Thirty-six out of 37 recruited participants completed the entire program including health assessments. Participants attended 63.5 % of the education series and attendance at each session was, on average, 62 % of those enrolled. There was a statistically significant improvement in cardiovascular health knowledge (p < 0.02). A higher percentage of participants meeting either ideal or intermediate LS7 score categories and a lower percentage within the poor category were observed. Higher LS7 scores correlated with higher psychosocial measures ratings.

CONCLUSIONS

Although small, our study suggests that the FAITH! program is a feasible, community intervention promoting ideal cardiovascular health that has the potential to improve cardiovascular health literacy and LS7 among African-Americans.

Conhecimento dos fatores de risco modificáveis para doença cardiovascular entre mulheres e seus fatores associados: um estudo de base populacional

Resumo O objetivo deste estudo foi avaliar o conhecimento dos fatores de risco modificáveis para a doença cardiovascular e sua distribuição em termos demográficos, socioeconômicos, comportamentais e biológicos entre mulheres residentes em Rio Grande, Rio Grande do Sul, Brasil. Foi um estudo transversal de base populacional, com a inclusão de mulheres com idade igual ou superior a 18 anos. Foram realizadas análise descritiva, bivariada e multivariável pela Regressão de Poisson. O desfecho foi definido como conhecer três ou mais dos sete fatores de risco pesquisados (percentil 75). De 1.593 entrevistadas, 33,0% conheciam três ou mais fatores. Foram associados de forma independente com maior probabilidade de conhecimento: a faixa etária de 25 a 44 anos, cor da pele não branca, ensino médio completo, maior renda e ser portadora da doença cardiovascular. Mulheres sedentárias apresentaram menor probabilidade de conhecimento. Os achados indicam a necessidade de ações educativas para melhorar a compreensão e o conhecimento dos fatores associados à doença cardiovascular, particularmente entre as mulheres mais pobres e menos escolarizadas.

Language barriers in Hispanic patients: relation to upper-extremity disability

BACKGROUND

Although upper-extremity disability has been shown to correlate highly with various psychosocial aspects of illness (e.g., self-efficacy, depression, kinesiophobia, and pain catastrophizing), the role of language in musculoskeletal health status is less certain. In an English-speaking outpatient hand surgery office setting, we sought to determine (1) whether a patient's primary native language (English or Spanish) is an independent predictor of upper-extremity disability and (2) whether there are any differences in the contribution of measures of psychological distress to disability between native English- and Spanish-speaking patients.

METHODS

A total of 122 patients (61 native English speakers and 61 Spanish speakers) presenting to an orthopaedic hand clinic completed sociodemographic information and three Patient-Reported Outcomes Measurement Information System (PROMIS)-based computerized adaptive testing questionnaires: PROMIS Pain Interference, PROMIS Depression, and PROMIS Upper-Extremity Physical Function. Bivariate and multivariable linear regression modeling were performed.

RESULTS

Spanish-speaking patients reported greater upper-extremity disability, pain interference, and symptoms of depression than English-speaking patients. After adjusting for sociodemographic covariates and measures of psychological distress using multivariable regression modeling, the patient's primary language was not retained as an independent predictor of disability. PROMIS Depression showed a medium correlation (r = -0.35; p < 0.001) with disability in English-speaking patients, while the correlation was large (r = -0.52; p < 0.001) in Spanish-speaking patients. PROMIS Pain Interference had a large correlation with disability in both patient cohorts (Spanish-speaking: r = -0.66; p < 0.001; English-speaking: r = -0.77; p < 0.001). The length of time since immigration to the USA did not correlate with disability among Spanish speakers.

CONCLUSION

Primary language has less influence on symptom intensity and magnitude of disability than psychological distress and ineffective coping strategies. Interventions to optimize mood and to reduce pain interference should be considered in patients of all nationalities.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Size misperception among overweight and obese families

BACKGROUND

Perception of body size is a key factor driving health behavior. Mothers directly influence children's nutritional and exercise behaviors. Mothers of ethnic minority groups and lower socioeconomic status are less likely to correctly identify young children as overweight or obese. Little evaluation has been done of the inverse--the child's perception of the mother's weight.

OBJECTIVE

To determine awareness of weight status among mother-child dyads (n = 506).

DESIGN

Cross-sectional study conducted in an outpatient pediatric dental clinic of Columbia University Medical Center, New York, NY.

PARTICIPANTS

Primarily Hispanic (82.2 %) mothers (n = 253), 38.8 ± 7.5 years of age, and children (n = 253), 10.5 ± 1.4 years of age, responding to a questionnaire adapted from the validated Behavioral Risk Factor Surveillance System.

MAIN MEASURES

Anthropometric measures-including height, weight, and waist circumference-and awareness of self-size and size of other generation were obtained.

KEY RESULTS

71.4 % of obese adults and 35.1 % of overweight adults underestimated size, vs. 8.6 % of normal-weight (NW) adults (both p < 0.001). Among overweight and obese children, 86.3 % and 62.3 % underestimated their size, vs. 14.9 % NW children (both p < 0.001). Among mothers with overweight children, 80.0 % underestimated their child's weight, vs. 7.1 % of mothers with NW children (p < 0.001); 23.1 % of mothers with obese children also underestimated their child's weight (p < 0.01). Among children with obese mothers, only 13.0 % correctly classified the adult's size, vs. 76.5 % with NW mothers (p < 0.001). Among obese mothers, 20.8 % classified overweight body size as ideal, vs. 1.2 % among NW mothers (p < 0.001).

CONCLUSION

Overweight/obese adults and children frequently underestimate their size. Adults misjudge overweight/obese children as being of normal weight, and children of obese mothers often underestimate the adult's size. Failure to recognize overweight/obesity status among adults and children can lead to prolonged exposure to obesity-related comorbidities.

Patients' understanding of their heart attack and the impact of exposure to a media campaign on pre-hospital time

BACKGROUND

Patients with acute myocardial infarction (AMI) have a limited understanding of AMI symptoms and risk factors. This can lead to delays in the recognition of an AMI and hospital presentation. We aimed to assess patients' understanding of their AMI symptoms and risk factors and also assess the impact of exposure to a media campaign on their pre-hospital time.

METHODS

We surveyed 100 AMI patients admitted to the Canberra Hospital. We asked them about their AMI symptoms and risk factors and the impact of the National Heart Foundation (NHF) advertisements on their AMI experience.

RESULTS

Only 26% of patients recognised that they were having an AMI. In 34% of cases, an ambulance was called. There was no significant difference in the median pre-hospital time between patients who encountered the NHF advertisements and those who had not (133 minutes vs. 137 minutes, p=0.809). Only 22% of patients could identify all of their personal AMI risk factors.

CONCLUSIONS

Most AMI patients do not initially recognise their condition nor do they call for an ambulance. Exposure to the NHF advertisements had no significant influence on reducing pre-hospital time in this cohort. Most patients have a limited understanding of AMI risk factors and causes.

The Impact of Hispanic Ethnicity on Knowledge and Behavior Among Patients With Diabetes

PURPOSE

The purpose of the study was to measure the current level of awareness of the American Heart Association's 7 risk/protective factors of cardiovascular health among adults with diabetes of Hispanic and non-Hispanic origin and to identify factors associated with knowledge deficits.

METHODS

A cross-sectional survey measured demographic data, personal behaviors/health factors, cardiovascular disease (CVD) history, and knowledge of 7 components of ideal cardiovascular health (smoking, obesity, exercise, diet, cholesterol, blood pressure, and blood glucose). A subset of 331 Hispanic and white patients with diabetes was surveyed. Knowledge scores were dichotomized between full knowledge (7 components) and less than full knowledge and compared between ethnicities using multiple logistic regression.

RESULTS

Seventy-nine percent of surveys were returned; 50.5% of subjects were Hispanic. Median age was 64.5 years with 60.7% being female. Two-thirds of the sample completed high school and 26% reported comorbid CVD. Recognition of diabetes as a risk factor didn't differ by ethnicity. Thirty-five percent of respondents identified 7 American Heart Association risk factors. Hispanics were less likely to identify 7 components. After adjustment for education and English literacy, the difference disappeared. Better knowledge was positively associated with healthier behaviors for high cholesterol, hypertension, and exercise only among white patients.

CONCLUSIONS

Hispanic patients with diabetes exhibit less knowledge about CVD risk/protective factors due to lower education and English literacy. Educational interventions should be tailored to those with less education/limited English proficiency.

[Is a patient's knowledge of cardiovascular risk factors better after the occurrence of a major ischemic event? Survey of 135 cases and 260 controls]

AIM

We hypothezised that patients (cases) who are hospitalized for a major ischemic event--myocardial infarction, stroke, decompensation of peripheral arterial disease--acquire better knowledge than a control population--atheromatous patients without a major ischemic event, patients consulting for a vein disease or a diabetes evaluation, and accompanists--about cardiovascular risk factors (smoking, hypertension, diabetes, dyslipidemia, obesity) and have a better understanding of the usefulness of making changes in their lifestyle (quit smoking, regular exercise, Mediterranean diet, low salt diet, weight control, diabetes care).

METHODS

A questionnaire was proposed at vascular surgery consultations and vascular and cardiac functional explorations, at the M Pavillon of the Édouard-Herriot hospital, Lyon, France. In five months, 395 questionnaires (135 cases and 260 controls) were analyzed.

RESULTS

The global knowledge score was statistically higher for cases than for controls (cases 3.23±1.81; controls 2.77±2.03; P=0.037). Cases did not abide by monitoring and dietary rules better, except as regards the management of diabetes. Regular physical activity was statistically more prevalent among controls than among cases. Cases mainly received their information from their doctors (general practitioner for 59% of controls and 78% of cases, cardiologist for 25% of controls and 57% of cases) while controls got their information more through magazines or advertising.

CONCLUSION

Our results show that after a major ischemic event, cases' knowledge of risk factors is better than the rest of the population without improved rules lifestyle changes. This suggests the usefulness of evaluating a therapeutic education program for atheromatous disease.

Increasing access to cholesterol screening in rural communities catalyzes cardiovascular disease prevention

PURPOSE

Despite increasing frequency, little evidence guides cholesterol screening in less traditional health care settings, such as rural health fairs.

METHODS

The Miller School of Medicine Department of Community Service (DOCS) is a student-run organization providing free basic health care to underserved South Florida communities. We retrospectively reviewed all new patients seen at 2007 DOCS rural fairs to describe their low-density lipoprotein (LDL) and high-density lipoprotein (HDL) values. In addition, we assessed if patient characteristics were associated with cholesterol abnormalities and whether patients with abnormalities who returned to a subsequent fair in 2008 or 2009 improved their cholesterol.

FINDINGS

Of 252 patients, 145 (58%) had an LDL cholesterol over 129 mg/dL and 61 (24%) had an HDL cholesterol below 40 mg/dL or 50 mg/dL for males and females, respectively. Baseline LDL cholesterol was not associated with body-mass index (BMI), age over 60 years, gender, healthy lifestyle habits, or insurance status. Of 36 patients with elevated LDL cholesterol and a follow-up screening, 24 (67%) reduced their LDL cholesterol by at least 16 mg/dL though reductions were not associated with BMI reduction, and 22 (61%) increased their HDL cholesterol by at least 5 mg/dL, trending with BMI reduction.

CONCLUSIONS

Cholesterol screening at rural fairs can identify a high proportion of patients with abnormal cholesterol, including those who might not be considered at high risk. Although this may catalyze favorable cholesterol changes, the lack of an association with weight loss suggests patients seek additional medical care, which should be considered before offering cholesterol screening at fairs.