Training and educational paperPublic perceptions and experiences of myocardial infarction, cardiac arrest and CPR in London☆
Introduction
Coronary disease (CD) is the most common cause of death in the United Kingdom, causing in excess of 117,000 deaths per year. CD is often associated with sudden cardiac arrest, the most common cause of which is myocardial infarction (“heart attack”) (MI).1 As the lay term for myocardial infarction is “heart attack”, this term was used in all study contacts with members of the public.
The sooner that treatments are administered after the onset of a myocardial infarction (MI), the greater the likelihood that damage to the heart is prevented or reduced. However, many individuals presenting with symptoms of MI delay calling for emergency medical help, thereby reducing their chances of recovery or survival through early access to definitive care.2 Median time intervals from onset of MI symptoms to accessing medical care range from 2 to 6.5 h,3, 4 and a critical factor influencing time in seeking professional medical help is recognition that symptoms are cardiac in origin.5, 6 Many cardiac patients and members of the general public have limited knowledge of the varied range of potential MI symptoms, and often fail to ascribe them to myocardial infarction.7, 8, 9, 10, 11, 12 The lay public also hold inaccurate perceptions of survival rates following cardiac arrest13, 14 and cardiopulmonary resuscitation (CPR).15
Contrary to public perception, chances of survival following out of hospital cardiac arrest of cardiac aetiology are typically low. For example, reported rates of survival to hospital discharge, calculated according to the Utstein guidelines,16 have ranged from 2% to 49%.17
Several factors, including early CPR, can significantly improve chances of surviving a witnessed out of hospital cardiac arrest.18, 19, 20, 21 Despite the benefits of the procedure, the incidence of bystander CPR is relatively low.22 A range of barriers to CPR have been identified, including: concern over disease transmission, particularly in relation to mouth to mouth ventilation,23, 24, 25 and lack of confidence in ability to perform the procedure effectively.26, 27 Barriers to undertaking CPR occur even when bystanders are offered telephone instructions prior to the arrival of the emergency medical services.28
An important prerequisite for being prepared to intervene in a cardiac arrest is previous CPR instruction.29 However, CPR is a complex skill that is difficult to acquire and retain,30 and targeting of CPR training has often failed to reach individuals most likely to be at the scene of a cardiac arrest.31, 32
In 2000, the London Ambulance Service NHS Trust (LAS) developed a comprehensive cardiac care strategy to achieve both the milestones and targets of the National Service Framework for Coronary Heart Disease,33 and impact on survival from out of hospital cardiac arrest. One element of the strategy was the formation of a Community Resuscitation Team involved in training members of the lay public in CPR and recognition of the signs and symptoms of a “heart attack” (myocardial infarction).
To promulgate the development of this training programme and a public awareness campaign (launched in October 2003), the LAS commissioned MORI Social Research Institute to undertake research with members of the lay public in Greater London in order to: explore public perceptions of a heart attack and cardiac arrest; investigate perceptions of survival following out of hospital cardiac arrest; measure levels of training and attitudes towards CPR, and explore types of interventions considered useful for increasing rates of bystander CPR.
Section snippets
Methods
A quantitative survey and a series of focus groups were conducted with members of the general public in Greater London by the MORI Social Research Institute on behalf of the London Ambulance Service NHS Trust (LAS).
The LAS serves a population of approximately 7.4 million, equating to a population density of 4699 people per km2, and representing 12% of the total UK population.34
Demographics
Interviews were conducted with 1011 participants, comprising 48% males (482/1011) and 52% females (529/1011) aged > 16. Seven percent (71/1011) of respondents reported having personal experience of coronary disease and 33% (331/1011) had a family member with CD. Table 1 presents the base line characteristics of the participants.
Knowledge of heart attack symptoms
Respondents were asked to consider possible symptoms of a heart attack (Table 2). The most commonly cited symptoms were chest pain (acknowledged by 87% of participants,
Discussion
This study offers important insight into how the lay public in London perceive MI and cardiac arrest; current levels of training and attitudes towards CPR, and perceptions of survival following out of hospital cardiac arrest. The findings are consistent with previous observations that the lay public have limited knowledge of the varied symptoms of myocardial infarction,35 they remain cautious about performing CPR on strangers,24, 36 and that they have inaccurate perceptions of survival
Conclusions
Each of these strategies might be useful in terms of either prompting members of the public to attend CPR training, or motivate those who have been trained to intervene in a cardiac emergency. In addition, concerns about mouth to mouth resuscitation that emerged in the current study support the need for further research to examine the effectiveness of chest compression only as an alternative to traditional CPR.
Acknowledgement
The quantitative survey and focus groups were conducted by MORI Social Research Institute on behalf of the London Ambulance Service NHS Trust.
References (42)
- et al.
Causes of delay in seeking treatment for heart attack symptoms
Soc Sci Med
(1995) - et al.
Public recognition of major signs and symptoms of heart attack: seventeen states and the US Virgin Islands
Am Heart J
(2004) - et al.
Societal opinions regarding CPR
Am J Emerg Med
(2002) - et al.
Public education regarding resuscitation: effects of a multimedia intervention
Ann Emerg Med
(2003) - et al.
Variation in outcome in studies of out-of-hospital cardiac arrest: a review of studies conforming to the Utstein guidelines
Am J Emerg Med
(2003) - et al.
Prehospital cardiac arrest: the impact of witnessed collapse and bystander CPR in a metropolitan EMS system with short response times
Ann Emerg Med
(1990) - et al.
Cardiac arrest resuscitation evaluation in los angeles: CARE-LA
Ann Emerg Med
(2005) - et al.
Community attitudes towards performing cardiopulmonary resuscitation in Western Australia
Resuscitation
(2001) - et al.
Obstacles to bystander cardiopulmonary resuscitation in Japan
Resuscitation
(2000) - et al.
Possibilities for, and obstacles to, CPR training among cardiac care patients and their co-habitants
Resuscitation
(2005)
Are we training the right people yet? A survey of participants in public cardiopulmonary resuscitation classes
Resuscitation
Cardiopulmonary resuscitation training for family members of patients on cardiac rehabilitation programmes in Scotland
Resuscitation
Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five US regions
Prev Med
Factors influencing Queenslanders’ willingness to perform bystander cardiopulmonary resuscitation
Resuscitation
Are we training the right people yet? a survey of participants in public cardiopulmonary resuscitation classes
Resuscitation
Quality and efficiency of bystander CPR Belgian Cerebral Resuscitation Study Group
Resuscitation
Coronary heart disease statistics 2004 ed.
Delay in calling for help during myocardial infarction: reasons for delay and subsequent pattern of accessing care
Heart
An international perspective on the time to treatment for acute myocardial infarction
J Nurs Scholarship
Analysis of prehospital delay among inner-city patients with symptoms of myocardial infarction: implications for therapeutic intervention
J Natl Med Assoc
Patients’ action during their cardiac event: qualitative study exploring differences and modifiable factors
BMJ
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Pre-Arrival Care of the Out-of-Hospital Cardiac Arrest Victim
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2011, Medicina IntensivaProspective evaluation of tools to assess the psychological response of CPR provision to a relative who has suffered a cardiac arrest: A pilot project
2011, ResuscitationCitation Excerpt :Few studies to date have attempted to access lay responders for the purposes of gauging the psychological implications of CPR provision. The general public has a perception, perpetuated by popular drama,28,29 that survival is the norm. Yet most studies report a survival rate from bystander witnessed out of hospital cardiac arrest of considerably less than 15%.30–33
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A Spanish translated version of the summary of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2006.03.003.