Cardiac symptom attribution and knowledge of the symptoms of acute myocardial infarction: a systematic review
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(2020) 20:445
RESEARCH ARTICLE
Open Access
Cardiac symptom attribution and knowledge of the symptoms of acute myocardial infarction: a systematic review Benedikt Birnbach, Jens Höpner and Rafael Mikolajczyk*
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. Keywords: Acute myocardial infarction, Acute coronary syndrome, Knowledge about symptoms, Symptom attribution, Awareness
Background About 15.9 million acute myocardial infarctions (AMIs) occurred in 2015 and the aggregated number of AMIs has increased by 6.4% from 2005 to 2015 [1]. With an ageing population, and rising prevalence of obesity and diabetes in many countries, the prevention and therapy * Correspondence: [email protected] Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
of cardiovascular disease will further increase in importance [1]. Since mortality or subsequent morbidity of AMI drastically decreases with a shorter time from symptoms-onset to reperfusion, [2–5] it is important to reduce any delays. One substantial component to ensure a timely treatment is patient delay, the time from symptoms-onset to seeking help. Here, attribution of symptoms to a cardiac cause has been found to be crucial [6–10]. In order to enable the patients to attribute the symptoms to the heart, knowledge of the symptoms of an AMI and t
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