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

Khurram Nasir, Shiwani Mahajan, Javier Valero-Elizondo, Rohan Khera, Nihar R. Desai, Ron Blankstein, Michael J. Blaha, Salim S. Virani, Bita A. Kash, William A. Zoghbi, Harlan M. Krumholz

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41 Citations (Scopus)


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 25271 individuals (13820 women [51.6%; 95% CI, 50.8%-52.4%]; 17910 non-Hispanic white individuals [69.9%; 95% CI, 68.2%-71.6%]; and 21826 individuals [82.7%; 95% CI, 81.5%-83.8%] born in the United States), 23383 (91.8%; 95% CI, 91.0%-92.6%) considered chest pain or discomfort a symptom of myocardial infarction; 22158 (87.0%; 95% CI, 86.1%-87.8%) considered shortness of breath a symptom; 22064 (85.7%; 95% CI, 84.8%-86.5%) considered pain or discomfort in arm a symptom; 19760 (77.0%; 95% CI, 76.1%-77.9%) considered feeling weak, lightheaded, or faint a symptom; and 16567 (62.6%; 95% CI, 61.6%-63.7%) considered jaw, neck, or back pain a symptom. Overall, 14075 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 <.001), not having been born in the United States (OR, 1.85; 95% CI, 1.47-2.33; P <.001), and having a lower education level (OR, 1.31; 95% CI, 1.09-1.58; P =.004). Among 294 non-Hispanic black or Hispanic individuals who were not born in the United States, belonged to the low-income or lowest-income subgroup, were uninsured, and had a lower education level, 61 (17.9%; 95% CI, 13.3%-23.6%) were not aware of any symptoms. This group had 6-fold higher odds of not being aware of any symptoms (OR, 6.34; 95% CI, 3.92-10.26; P <.001) compared with individuals without these characteristics. Overall, 1130 individuals (4.5%; 95% CI, 4.0%-5.0%) chose a different response than calling emergency medical services in response to a myocardial infarction. Conclusions and Relevance: Many 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..

Original languageEnglish
Article number190674
JournalJAMA network open
Issue number12
Publication statusPublished - 18 Dec 2019
Externally publishedYes


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