title: Awareness of heart attack symptoms among US adults in 2007, and changes in awareness from 2001 to 2007.
abstract: OBJECTIVE
  Timely access to emergency care, prompt receipt of advanced treatment and survival from heart attack is dependent on both the early recognition of heart attack symptoms, by both victims and bystanders, and by immediately calling the emergency services. The objective of this study is to measure the awareness of heart attack symptoms and the emergency response among US adults.
  
  
  METHODS
  We analyzed data from the Behavioral Risk Factor Surveillance System's module on heart attack and stroke, which was conducted in 17 states/territories in 2001 and 12 states/territories in 2007. The module included five questions related to heart attack symptoms, one decoy question and one question regarding the first action to take if someone is having a heart attack. Age-adjusted prevalence of awareness was estimated, and odds ratios were calculated. Differences between 2001 and 2007 were assessed for five states that used the module in both years.
  
  
  RESULTS
  In 2007, among 76,864 adults, awareness of individual heart attack symptoms ranged from 49% (pain in jaw, neck or back) to 92% (chest pain). Although 97% of adults recognized at least one symptom, only 10.7% recognized all five symptoms, knew that 'sudden trouble seeing in one or both eyes' was not a symptom of heart attack and recognized the need to call the emergency services. This estimate varied significantly by age, sex, race/ethnicity and level of education. The estimate was significantly higher for women (12.2%) than men (7.7%), White (11.6%) than Black (5.7%) or Hispanic people (4.5%), those with a higher level of education (13.5%) than lower educational level (4.5%) and for those with coronary heart disease (16.2%) than without the disease (9.5%). Comparison of awareness between 2001 (the referent) and 2007, in five states, revealed that awareness of all symptoms and calling the emergency services, were 9.7 and 10.3% for 2001 and 2007, respectively (p < 0.01). Compared to 2001, the odds ratio of awareness in 2007 was 1.08 (95% CI: 0.99-1.19) after controlling for socioeconomic and clinical characteristics.
  
  
  CONCLUSIONS
  Awareness of all heart attack symptoms among adults in 12 states was low and little improvement was observed between 2001 and 2007. Accordingly, both clinicians and public health officials should seek ways in order to increase public awareness of the symptoms of heart attack. Special efforts should be focused on men, Black and Hispanic people and those with only modest levels of education.
authors.affiliation: Division for Heart Disease & Stroke Prevention, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control & Prevention, Atlanta, GA, USA. jfang@cdc.gov
authors.forename: Jing
authors.initials: J
authors.lastname: Fang
authors.forename: Cathleen
authors.initials: C
authors.lastname: Gillespie
authors.forename: Nora L
authors.initials: NL
authors.lastname: Keenan
authors.forename: Kurt J
authors.initials: KJ
authors.lastname: Greenlund
mesh_terms: D001364:Awareness; D016001:Confidence Intervals; D003625:Data Collection; D004638:Emergency Treatment; D005006:Ethnicity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000473:pathology; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States