Do Americans Know the Signs of a Heart Attack? 2008–2017

This page summarizes a CDC report in MMWR using National Health Interview Survey data from 2008, 2014 and 2017.

Heart disease is the leading cause of death in the United States, and an estimated 750,000 heart attacks (myocardial infarctions) happen every year, when part of the heart muscle doesn't get enough blood. Acting fast saves lives: victims or bystanders need to recognize the symptoms and call 9-1-1 right away so emergency care arrives in time.

The five common symptoms

1. pain or discomfort in the jaw, neck or back;
2. feeling weak, lightheaded or faint;
3. chest pain or discomfort;
4. pain or discomfort in the arms or shoulder;
5. shortness of breath.

The survey

In 2008, 2014 and 2017 the National Health Interview Survey asked adults five yes-or-no questions on whether each of these was a heart attack symptom, and what the best thing to do right away would be if they thought someone was having a heart attack. The correct answer was to call 9-1-1 or another emergency number. After excluding about 1% with missing answers, the samples were 21,525 (2008), 36,289 (2014) and 26,480 (2017). Results were adjusted for age, sex, race and ethnicity, education, history of coronary heart disease and number of cardiovascular risk factors (high blood pressure, high cholesterol, diabetes, smoking and obesity).

Findings

Both rose significantly. Symptom knowledge rose in every subgroup except people with four or five cardiovascular risk factors; knowing to call 9-1-1 rose in every group except non-Hispanic Asian adults and people with coronary heart disease.

Who knew less in 2017:

• Symptoms: men, younger adults, racial and ethnic minorities (especially non-Hispanic Asian and Hispanic adults) and people with less education.
• Calling 9-1-1: men, adults 65 and older, non-Hispanic Asian adults, people without a high school diploma, and people with four or five risk factors.

Progress against targets

Healthy People 2020 set targets using the 2008 figures as a baseline: 43.6% knowing all five symptoms (a 10% increase) and 93.8% knowing to call 9-1-1 (a 2% increase). By 2017 both were met overall, but not for some groups, including racial and ethnic minorities and adults without a high school education. For comparison, in 14 states in the 2005 Behavioral Risk Factor Surveillance System, 31% knew all five symptoms and 85.8% knew to call 9-1-1 first.

What it means

Even after years of campaigns by CDC, the National Heart, Lung, and Blood Institute and partners such as the American Heart Association, only about half of adults know all five symptoms. The authors call for consistent messaging together with regular contact with a health care provider, where screening and evaluation can lead to early intervention, and for focused education in clinical, community and public health settings, especially for minority groups, people with less education and people with more risk factors.

Limitations

• Answers were self-reported and subject to recall and social desirability bias.
• The yes-or-no questions listed only correct symptoms, which may overstate knowledge.
• The survey excludes people in nursing homes, long-term care, prisons and similar settings.

Sources

• Fang J, Luncheon C, Ayala C, Odom E, Loustalot F. "Awareness of Heart Attack Symptoms and Response Among Adults — United States, 2008, 2014, and 2017." MMWR 68(5). https://www.cdc.gov/mmwr/volumes/68/wr/mm6805a2.htm