Women May Have Large Knowledge Gap of Heart Disease Risks and Symptoms

Lisa A. McDonnell Program Manager, Prevention & Wellness Centre, Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.MedicalResearch.com Interview with:
Lisa A. McDonnell
Program Manager, Prevention & Wellness Centre,
Division of Prevention and Rehabilitation,
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Medical Research: What are the main findings of the study?

Answer: The analysis focuses on a comparison of women’s perceptions of their heart disease knowledge and heart health risk with their self‐reported knowledge and heart health risk status. In summary, it gives insight into the Perceptions vs Reality when it comes to women and their heart health.

Heart disease knowledge:
For the purposes of measuring knowledge related to heart health, a scoring index was created on which women responding to the survey could score as low as 0 or as high as 40. The overall mean score among women in the survey was 15.0, which is fairly modest given the maximum of 40. In a comparison of actual and perceived heart disease knowledge, 80% of respondents with a low knowledge score perceived that they were moderately or well informed.

The risk factors that Canadian women most commonly associate with heart disease are being overweight/having abdominal obesity (ov/ob), physical inactivity, smoking, and lacking fruits/vegetables. Smoking, diabetes and high blood pressure account for up to 53% of MI’s, followed by Ov/Ob, psychosocial factors, a lack of physical activity, and a lack of fruits/vegetables. The limited awareness of high blood pressure, high cholesterol and diabetes as key risk factors is particularly surprising, given that these are key determinants of heart disease.

Low awareness of symptomology among women in our survey were noted when comparing the occurrence of symptoms versus their recognition of these symptoms as possibly being related to their heart. Only 4 in 10 women could name chest pain as a symptom of heart disease, and a smaller proportion could identify symptoms including dyspnea, radiating pain, or typical prodromal symptoms. Such shortcomings might contribute to the greater number of unrecognized myocardial infarctions in women than in men, not to mention inappropriate treatment of acute events and premature discharge from emergency care.
Actual, perceived heart risk:

A substantial proportion of women classified as at risk of heart disease by virtue of their lifestyle practices or medical history significantly underestimated their level of risk. For instance, 17% of women were at a high medical risk for CVD but 60% perceived their level of risk to be low or moderate.

Attitudes and beliefs regarding responsibility for health:

65% of women indicated that they have the greatest influence over their family’s health. This finding highlights the impact that women can have on the heart health of their families when targeted for CVD risk management interventions.

Medical Research: Were any of the findings unexpected?

Answer: For the most part, the findings validate some of the outcomes that have been noted in the American and European literature published on women’s heart health. What was surprising was the degree to which women’s perceptions differed from reality. An average knowledge score of 38% was lower than expected, and the number of women who underestimated their risk for CVD was higher than expected.

The majority of women (65%) who have had an incident of heart attack or stroke view their heart health as a chronic condition requiring continuous management of risk factors. Nonetheless, 35% view their event as only an episode that has now been treated, after which they resumed their pre‐diagnosis lifestyle. This ‘Out of Sight, Out of Mind Phenomenon’ was expected but not in 1/3 of the sample.

In the evidence, Physicians report that discussions about CVD prevention occur in only a minority of office visits; approximately 38% of the time. However, in our survey 55% of women reported that they routinely discuss prevention and lifestyle practices with their health care provider.

Medical Research: What should clinicians and patients take away from your report?

Answer:  Women’s symptoms of MI and other ACS are often labeled “atypical” because they differ from the classic symptoms traditionally found in men. Women will often believe that their collection of symptoms are too different from the classic symptoms to warrant concern or medical attention; this is an important factor in the delay of women in seeking health care when experiencing ACS (Am Heart J 2012;163:39‐48.e1). Many women experience prodromal symptoms for up to a year before an MI, including unusual fatigue, anxiety, chest discomfort, indigestion, shortness of breath, sleep disturbances, and weakness. Women are less likely to have classic angina, and more likely to have angina that continues with rest, pain that awakens them from sleep, nonspecific changes on ECG, nausea, and sensations in the neck throat, back, and jaw (Am J Primary Health Care 2011;36(9):22‐27).
Both clinicians and women need to be aware of the symptoms that could be indicative of a cardiac event. It is important that women maintain a log of any recurring symptoms and bring this to the attention of a clinician, and for clinicians to respond with diagnostic tests that are known to be more accurate in detecting CVD in women – when in doubt, check it out!

The finding that more than a third of women who had been treated for heart disease assumed that they could resume their pre‐diagnosis lifestyle underscores the need to better inform patients of the disease’s chronicity and the effects that day‐to‐day risk‐reducing activities can have on its trajectory.

Patients need to understand that risk factor management post a cardiac event is critical to minimizing the occurrence of a recurrent event.

Change presupposes a requisite set of knowledge and attitudes. Results of the survey suggest that despite the fact that women are generally predisposed to take on responsibility for their heart health, a significant proportion lack the knowledge or insight to do so. Furthermore, many who are at risk of developing heart disease due to lifestyle practices are unaware of their risk, and of ameliorative measures that could be taken. Women’s strong preference for a physician to be their primary source of

information regarding heart health emphasizes the potential opportunity for patient education and the influence doctors have in discussing heart healthy practices with their female patients.

Medical Research: What recommendations do you have for future research as a result of this study?

Answer: Being that knowledge is a pre‐requisite of health‐related attitudes and behaviors, the root causes behind the problem of insufficient knowledge of heart disease symptoms and risk factors should be further studied. Further investigation into the socioeconomic variables and cultural factors that impact heart health awareness, attitudes, and lifestyle is warranted.

Future prospective studies should be conducted to evaluate the impact of women on of the health of others, and the factors as to why Canadian women report higher engagement in prevention discussions with their healthcare providers.

Perceived vs Actual Knowledge and Risk of Heart Disease in Women: Findings From a Canadian Survey on Heart Health Awareness, Attitudes, and Lifestyle
McDonnell LA1, Pipe AL2, Westcott C2, Perron S2, Younger-Lewis D2, Elias N2, Nooyen J2, Reid RD2.
Can J Cardiol. 2014 Jul;30(7):827-34. doi: 10.1016/j.cjca.2014.05.007. Epub 2014 May 13.