REACT focus groups found that, overwhelmingly, participants expected that heart attack symptoms would correspond to common Hollywood movie portrayals as sharp crushing chest pain or collapse, such as a cardiac arrest. They thought there would be no doubt about the nature of the event that was occurring. This was in sharp contrast to the actual experience of heart attack symptoms described by participants (53).
In addition to expecting a dramatic chest clutching presentation, knowledge of the complex array of heart attack symptoms, even the more common ones, is lacking in the American public. A random-digit-dialed telephone survey conducted among 1294 adult respondents in 20 communities from the REACT research program revealed that knowledge of chest pain as a presenting heart attack symptom was high and relatively uniform (89.7%). However, knowledge of some of the other associated symptoms was suboptimal. Only two-thirds (67.3%) identified arm pain as a symptom; shortness of breath was cited by half (50.8%) of the respondents, sweating was named by one-fifth (21.3%) of those surveyed, and other heart attack symptoms were less common. The median number of correct symptoms reported was 3 (of 11). 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. Thus knowledge of chest pain (even though there is a misconception that it will be dramatic in nature) 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. The authors concluded that at the earliest stages, delay in the recognition of symptoms as being caused by a heart attack, may be due to inadequate knowledge of heart attack symptoms or misattribution of the symptoms to another, noncardiac, and potentially less severe cause. They recommended that efforts to reduce delay in seeking medical care among persons with heart attack symptoms should address these deficiencies in knowledge (54).
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