Atlanta, GA - A survey in 14 US states has found that less than a third of adults are aware of all five warning signs and symptoms of MI and would call 911 first in the event of an MI [1]. There were variations in awareness between races and between the sexes and also by geographic region and education, say Dr J Fang (US Centers for Disease Control and Prevention, Atlanta, GA) and colleagues in their report published online February 22, 2008 in Morbidity and Mortality Weekly Report.

Public-health measures should target blacks, Hispanics, men, and persons with less education.

"The disparities observed in this report by race/ethnicity, sex, and education level, with higher levels of awareness among whites, women, and persons with a college education, suggest that public-health measures should target blacks, Hispanics, men, and persons with less education," they say.

In addition, the state and local departments of health in states with lower awareness should collaborate to implement general public-awareness campaigns to increase the percentage of people who are both aware of all five signs and symptoms and who know to call 911 immediately if a person is having a heart attack or stroke, they stress.

Fang et al explain that around 50% of all cardiac deaths occur within one hour of symptom onset, before patients reach a hospital, so timely access to emergency cardiac care is imperative. This in turn depends upon early recognition of the warning signs and symptoms of a heart attack both by those experiencing the attack and bystanders and immediately calling 911.

For the current study, they accessed the Behavioral Risk Factor Surveillance System (BRFSS), a state-based, random-digit-dialed telephone survey of the US population from 2005 and included self-reported data from almost 72 000 respondents in 14 states that included questions on signs and symptoms of a heart attack. An incorrect symptom—sudden trouble seeing in one eye—was included in the survey to assess the possibility that people would answer "yes" to all the items in a series of closed-ended questions.

Respondents were also asked to choose the one action that they would take first, from the following, if they thought that a person was having a heart attack or stroke: take the person to the hospital, advise the person to call a doctor, call 911, call a spouse or family member, or do something else.

Although respondent awareness of some of the five major signs and symptoms of MI was quite high, it was lower for others: pain or discomfort in the jaw, neck, or back (48%); feeling weak, lightheaded, or faint (62%); chest pain or discomfort (92%); pain or discomfort in the arms or shoulder (85%); and shortness of breath (93%). A total of 86% of respondents reported that they would call 911 if they thought someone were having a heart attack or stroke.

Awareness of each of the five major heart-attack warning signs and symptoms varied by race/ethnicity, sex, level of education, and by state. Awareness was highest in West Virginia (35.5%) and lowest in DC (16.0%). The other states surveyed were: Alabama, Florida, Iowa, Louisiana, Maine, Minnesota, Mississippi, Missouri, Oklahoma, Tennessee, and Virginia.

When it came to awareness of all five signs and symptoms of MI, results were poorer, however, with only 31% of respondents knowing all five signs and just 27% recognizing all signs and saying their initial impulse would be to call 911. Furthermore, only 16% of people were aware of all five signs plus the one incorrect sign inserted into the survey and said they would call 911 first.

"Mortality from heart attack would decrease if patients received medical assistance more quickly, [and] research suggests that patient delays in seeking help are a major factor related to delay in care," say Fang et al.

"Because only approximately one third of the surveyed population knew all five correct heart-attack signs and symptoms, state and local public-health measures should be developed to improve public awareness of heart-attack warning signs and symptoms," they conclude.