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What Do Patients Know?

Kathleen Dracup, DNSc; Sharon McKinley, RN, PhD; Lynn V. Doering, RN, DNSc; Barbara Riegel, RN, DNSc; Hendrika Meischke, PhD; Debra K. Moser, RN, DNSc; Michele Pelter, RN, PhD; Beverly Carlson, RN, MS; Leanne Aitken, RN, PhD; Andrea Marshall, RN, MS; Rebecca Cross, RN, PhD; Steven M. Paul, PhD

Arch Intern Med. 2008;168(10):1049-1054.

Background  The effectiveness of therapy for an acute coronary syndrome (ACS) is dependent on patients' quick decision to seek treatment. We surveyed patients' level of knowledge about heart disease and self-perceived risk for a future acute myocardial infarction (AMI) in patients with documented ischemic heart disease.

Methods  Patients (N = 3522) had a mean age of 67 years, 68% were male, and all had a history of AMI or invasive cardiac procedure for ischemic heart disease. Data were gathered using a 26-item instrument focusing on ACS symptoms and appropriate steps to seeking treatment. Patients were asked to identify their level of perceived risk for a future AMI.

Results  Forty-six percent of patients had low knowledge levels (ie, <70% of answers were correct). The mean score was 71%. Higher knowledge scores were significantly related to female sex (P  = .001), younger age (P  = .001), higher education (P  = .001), participation in cardiac rehabilitation (P  = .001), and receiving care by a cardiologist rather than an internist or general practitioner (P  = .005). Clinical history (eg, AMI [P  = .24] and cardiac surgery [P  = .38]) were not significant predictors of knowledge. Most (57%) identified themselves as being at higher risk for a future AMI compared with an age-matched individual without heart disease with 1 exception. Namely, patients who had undergone coronary artery bypass surgery felt significantly less vulnerable for a future AMI than other individuals of the same age.

Conclusions  Even following diagnosis of ACS and numerous interactions with physicians and other health care professionals, knowledge about ACS symptoms and treatment on the part of patients with cardiac disease remains poor. Patients require continued reinforcement about the nature of cardiac symptoms, the benefits of early treatment, and their risk status.

Author Affiliations: School of Nursing, University of California, San Francisco (Drs Dracup and Paul); Critical Care Nursing Professorial Unit, Northern Sydney Central Coast Health and University of Technology Sydney, Sydney, Australia (Dr McKinley and Ms Marshall); School of Nursing, University of California, Los Angeles (Drs Doering and Cross); School of Nursing, University of Pennsylvania, Philadelphia (Dr Riegel); Department of Health Services, University of Washington, Seattle (Dr Meischke); School of Nursing, University of Kentucky, Lexington (Dr Moser); School of Nursing, University of Nevada, Reno (Dr Pelter); Sharpe HealthCare, San Diego, California (Ms Carlson); and Research Centre for Clinical and Community Practice Innovation, Griffith University, Brisbane, Australia (Dr Aitken).

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