Dataset Information

Variation and Disparities in Awareness of Myocardial Infarction Symptoms Among Adults in the United States.

ABSTRACT:

Importance

Prompt recognition of myocardial infarction symptoms is critical for timely access to lifesaving emergency cardiac care. However, patients with myocardial infarction continue to have a delayed presentation to the hospital.

Objective

To understand the variation and disparities in awareness of myocardial infarction symptoms among adults in the United States.

Design, setting, and participants

This cross-sectional study used data from the 2017 National Health Interview Survey among adult residents of the United States, assessing awareness of the 5 following common myocardial infarction symptoms among different sociodemographic subgroups: (1) chest pain or discomfort, (2) shortness of breath, (3) pain or discomfort in arms or shoulders, (4) feeling weak, lightheaded, or faint, and (5) jaw, neck, or back pain. The response to a perceived myocardial infarction (ie, calling emergency medical services vs other) was also assessed.

Main outcomes and measures

Prevalence and characteristics of individuals who were unaware of myocardial infarction symptoms and/or chose not to call emergency medical services in response to these symptoms.

Results

Among 25?271 individuals (13?820 women [51.6%; 95% CI, 50.8%-52.4%]; 17?910 non-Hispanic white individuals [69.9%; 95% CI, 68.2%-71.6%]; and 21?826 individuals [82.7%; 95% CI, 81.5%-83.8%] born in the United States), 23?383 (91.8%; 95% CI, 91.0%-92.6%) considered chest pain or discomfort a symptom of myocardial infarction; 22?158 (87.0%; 95% CI, 86.1%-87.8%) considered shortness of breath a symptom; 22?064 (85.7%; 95% CI, 84.8%-86.5%) considered pain or discomfort in arm a symptom; 19?760 (77.0%; 95% CI, 76.1%-77.9%) considered feeling weak, lightheaded, or faint a symptom; and 16?567 (62.6%; 95% CI, 61.6%-63.7%) considered jaw, neck, or back pain a symptom. Overall, 14?075 adults (53.0%; 95% CI, 51.9%-54.1%) were aware of all 5 symptoms, whereas 4698 (20.3%; 95% CI, 19.4%-21.3%) were not aware of the 3 most common symptoms and 1295 (5.8%; 95% CI, 5.2%-6.4%) were not aware of any symptoms. Not being aware of any symptoms was associated with male sex (odds ratio [OR], 1.23; 95% CI, 1.05-1.44; P?=?.01), Hispanic ethnicity (OR, 1.89; 95% CI, 1.47-2.43; P?Conclusions and relevanceMany adults in the United States remain unaware of the symptoms of and appropriate response to a myocardial infarction. In this study, several sociodemographic subgroups were associated with a higher risk of not being aware. They may benefit the most from targeted public health initiatives.

SUBMITTER: Mahajan S

PROVIDER: S-EPMC6991230 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Publications

Variation and Disparities in Awareness of Myocardial Infarction Symptoms Among Adults in the United States.

Mahajan Shiwani S Valero-Elizondo Javier J Khera Rohan R Desai Nihar R NR Blankstein Ron R Blaha Michael J MJ Virani Salim S SS Kash Bita A BA Zoghbi William A WA Krumholz Harlan M HM Nasir Khurram K

JAMA network open 20191202 12

<h4>Importance</h4>Prompt recognition of myocardial infarction symptoms is critical for timely access to lifesaving emergency cardiac care. However, patients with myocardial infarction continue to have a delayed presentation to the hospital.<h4>Objective</h4>To understand the variation and disparities in awareness of myocardial infarction symptoms among adults in the United States.<h4>Design, setting, and participants</h4>This cross-sectional study used data from the 2017 National Health Intervi ...[more]

PMID: 31851350

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Project description:The aim of this study is to assess for regional variation in the incidence of postoperative myocardial infarction (POMI) following nonemergent vascular surgery across the United States to identify potential areas for quality improvement initiatives.We evaluated POMI rates across 17 regional Vascular Quality Initiative (VQI) groups that comprised 243 centers with 1,343 surgeons who performed 75,057 vascular operations from 2010 to 2014. Four procedures were included in the analysis: carotid endarterectomy (CEA, n = 39,118), endovascular abdominal aortic aneurysm (AAA) repair (EVAR, n = 15,106), infrainguinal bypass (INFRA, n = 17,176), and open infrarenal AAA repair (OAAA, n = 3,657). POMI was categorized by the method of diagnosis as troponin-only or clinical/ECG and rates were investigated in regions with ?100 consecutive cases. Regions with significantly different POMI rates were defined as those >1.5 interquartile lengths beyond the 75th percentile of the distribution. Risk-adjusted rates of POMI were assessed using the VQI Cardiac Risk Index all-procedures prediction model to compare the observed versus expected rates for each region.Overall rates of POMI varied by procedure type: CEA 0.8%, EVAR 1.1%, INFRA 2.7%, and OAAA 4.2% (P < 0.001). Significant variation in POMI rates was observed between regions, resulting in differing ranges of POMI rates for each procedure: CEA 0.5-2.0% (P = 0.001), EVAR 0.3-3.1% (P < 0.001), INFRA 1.1-4.8% (P < 0.001), and OAAA 2.2-10.0% (P < 0.001). A single region in 3 of the 4 procedure-specific datasets was identified as a statistical outlier with a significantly higher POMI rate after CEA, EVAR, and OAAA; this region was identical for the EVAR and OAAA datasets but was a different region for the CEA dataset. No significant variation in POMI was noted between regions after INFRA. Procedure-specific clinical POMI rates (mean; range) were significantly different between regions for EVAR (0.4%; 0-1.1%, P = 0.01) and INFRA (1.4%; 0.5-2.9%, P = 0.01), but not for CEA (0.4%; 0-0.8%, P = 0.53) or OAAA (1.6%; 0-3.8%, P = 0.23). Procedure-specific troponin-only POMI rates (mean; range) were significantly different between regions for all procedures: CEA (0.4%; 0.1-1.2%, P < 0.001), EVAR (0.7%; 0-2.1%, P < 0.001), INFRA (1.3%; 0.4-2.5%, P = 0.001), and OAAA (2.5%; 0-8.5%, P < 0.001). After risk adjustment, regional variation was again noted with 3 regions having higher and 4 regions having lower than expected rates of POMI.Significant variation in POMI rates following major vascular surgery exists across VQI regions even after risk adjustment. These findings may present an opportunity for focused regional quality improvement efforts.

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Dataset Information

Variation and Disparities in Awareness of Myocardial Infarction Symptoms Among Adults in the United States.

Importance

Objective

Design, setting, and participants

Main outcomes and measures

Results

Publications

Variation and Disparities in Awareness of Myocardial Infarction Symptoms Among Adults in the United States.

Similar Datasets

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