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Original research article
Public knowledge of cardiovascular disease and response to acute cardiac events in three cities in China and India
  1. Herbert C Duber1,2,
  2. Claire R McNellan1,
  3. Alexandra Wollum1,
  4. Bryan Phillips1,
  5. Kate Allen1,
  6. Jonathan C Brown1,
  7. Miranda Bryant1,
  8. R B Guptam3,
  9. Yichong Li4,
  10. Piyusha Majumdar3,
  11. Gregory A Roth1,5,
  12. Blake Thomson1,
  13. Shelley Wilson1,
  14. Alexander Woldeab1,
  15. Maigeng Zhou4,
  16. Marie Ng1
  1. 1 Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
  2. 2 Division of Emergency Medicine, University of Washington, Seattle, USA
  3. 3 Gfk, Delhi, India
  4. 4 Chinese Center for Disease Control and Prevention, Beijing, China
  5. 5 Division of Cardiology, University of Washington, Seattle, USA
  1. Correspondence to Dr Herbert C Duber, Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave, Suite 600, Seattle, WA 98121, USA; hduber{at}


Objective To inform interventions targeted towards reducing mortality from acute myocardial infarction (AMI) and sudden cardiac arrest in three megacities in China and India, a baseline assessment of public knowledge, attitudes and practices was performed.

Methods A household survey, supplemented by focus group and individual interviews, was used to assess public understanding of cardiovascular disease (CVD) risk factors, AMI symptoms, cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs). Additionally, information was collected on emergency service utilisation and associated barriers to care.

Results 5456 household surveys were completed. Hypertension was most commonly recognised among CVD risk factors in Beijing and Shanghai (68% and 67%, respectively), while behavioural risk factors were most commonly identified in Bangalore (smoking 91%; excessive alcohol consumption 64%). Chest pain/discomfort was reported by at least 60% of respondents in all cities as a symptom of AMI, but 21% of individuals in Bangalore could not name a single symptom. In Beijing, Shanghai and Bangalore, 26%, 15% and 3% of respondents were trained in CPR, respectively. Less than one-quarter of participants in all cities recognised an AED. Finally, emergency service utilisation rates were low, and many individuals expressed concern about the quality of prehospital care.

Conclusions Overall, we found low to modest knowledge of CVD risk factors and AMI symptoms, infrequent CPR training and little understanding of AEDs. Interventions will need to focus on basic principles of CVD and its complications in order for patients to receive timely and appropriate care for acute cardiac events.

  • Cardiac arrest
  • acute myocardial infarction
  • global health
  • health services

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  • Contributors HCD oversaw all parts of the analysis, interpreted results and wrote the first draft of the manuscript. CRM contributed to development of methods, produced all figures and assisted with interpretation of findings and manuscript writing. AWoll, BP, KA, GAR, BT and AWold contributed to project development, data analysis and interpretation. JCB, MB and SW contributed to project development, management and manuscript writing. RBG, PM, YL and MZ led country-level facility data collection and interpretation of results. MN conceptualised the project and provided guidance on data analysis and manuscript writing. All authors read and approved the final manuscript.

  • Funding This study was supported by a grant from the Medtronic Foundation as part of the Global HeartRescue Project. The funder had no role in study design, data collection, analysis, interpretation of data, writing of the manuscript or the decision to submit for publication.

  • Competing interests None declared.

  • Ethics approval Ethical approval was obtained from local institutional review boards in China (National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention) and India (Centre for Media Studies).

  • Provenance and peer review Not commissioned; externally peer reviewed.