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Take It To Heart

Literature Review
Jenee M. Carr
HLTH 634-Fall D01
12 November 2015

The purpose of this literature review is to provide an evidence-based foundation for the
Take It To Heart health communication initiative that seeks to increase awareness of and
response to heart attack symptoms within the adult population, aged 20 and over. The need for
enhanced heart health stems from the unsettling statistic labeling coronary heart disease as the
leading cause of death for all age groups in the United States.1 Most of these deaths are also
deemed preventable by both succumbing to fewer risk factors and by bettering medical
treatment.2 The governmental initiative, Healthy People 2020, has realized these needs and
enacted numerous objectives to create a nation that is more heart-conscious and empowered to
overcome the risk of poor heart health. The Take It To Heart intervention seeks to address this
national problem and has started by first reviewing evidence-based findings on heart health
promotion and prevention measures. The following sources presented in this review will
highlight the appropriate demographics to target in addressing this health concern (i.e. gender,
age, educational attainment) and will also demonstrate the need for such heart care intervention,
provide extensive statistical data on heart disease, and present recommendations for future
program planning.
The proposed intervention, Take It To Heart, will utilize educational activities through a
web-based platform that challenges adults, especially young adults, to learn the symptoms of a
heart attack and how to respond appropriately and quickly. These activities will include
educational sessions, role-playing and hands-on demonstrations. Educational material will be
presented through online seminars/presentations and video blogs that detail what a heart attack
may look like in both males and females and will present memorable steps for response. Roleplaying will allow participants to act out scenarios with fellow peers in order to build confidence

and raise awareness of these heart health concerns. Finally, demonstrations will include various
forms of past heart attack survivors or witnesses that can relay what the experience was like for
them and how they would react differently after learning about heart care. By physically
rehearsing these behaviors, retention of the lessons learned will hope to be enhanced and will be
more quickly available for future use in emergency situations.3 Because of the high prevalence of
poor heart health within our nation and the need for enhanced educational strategies that foster
confidence and sense of responsibility, Take It To Heart has been created.
The following literature review will first describe the body of evidence attained on
various aspects of this health communication initiative. Data on heart disease prevalence,
demographic disparities, heart disease risk factors and many other areas of knowledge will be
presented to summarize the evidence supporting the need for heart health education. In the final
section, main contributions of this data will be highlighted and the review will conclude with
overall research findings that link such empirical evidence to the Take It To Heart Initiative.
Selection criteria for references in this review included only peer-reviewed journal articles
published within the last eight years as well as scientific data reports presented by certain health
government agencies. Certain publications were omitted, such as newspaper articles, to ensure
the literature reviewed held the highest quality. Key words used to obtain these articles included
heart health, awareness, heart attack symptoms, education, environment, young adults, etc.. All
ethnic groups were considered as all are subject to the threat of a heart attack. The retrieval of
literature focused more on the young adult age range, ages 20-30. With all this in mind, the
following paragraphs will present the findings of this search.

Body of Evidence
MMWRs (Morbidity and Mortality Weekly Report) were first reviewed in order to gain
insight on recent health information and recommendations for public heart health. These reports
are based on scientific data presented to the Center for Disease Control and Prevention by
various health departments, statewide. Two of these scientific publications presented by the
CDC governmental agency have highlighted both the lack of comprehensive awareness and
knowledge of heart attack symptoms as well as the importance of prevention measures to be
targeted at younger adult populations.2,4 Specifically, awareness of all warning signs of a heart
attack was as low as 31% in a telephone survey data analysis of 14 states.4 Poor response to such
attacks have even been attributed to over 200,000 preventable heart attack deaths in the year
2010 alone.2 These governmental reports present frightening statistics in the serious issue of
heart health and have been highlighted throughout the scientific literature to address proper
prevention measures through both medical care and public health professionals. They have
echoed the known need for more heart health education and have supported a target audience that
holds some focus on younger adults.
Other peer-reviewed journal articles have set out to define the workings of cardiovascular
disease and have theoretically analyzed the factors behind poor heart health while identifying
proposed prevention measures. Common findings address risk factor reduction in the adult
population and how young adults live in a critical timeframe for defining and establishing
healthy lifestyle practices.1,5 One study even presented a conceptual pathway to highlight the
linkages between various prevention approaches (i.e. clinically-based, skill building programs,
peer and community connections, etc.) and their relation to strengthened cardiovascular health.5
This conceptual analysis again showed the need for prevention measures to be presented earlier

in adulthood in order to combat risk factors relating to peer influence, confidence in behavior
change and connection to resources .5,6 One specific prevention measure that has been seen
throughout literature is the use of clinical screenings for such cardiovascular risk factors.7 By
maintaining routine screenings and identifying particular genetic or environmental factors, as
discussed in a large genome-phenome study, heart health can be identified early on and acted
upon by the individual.6,7 These theoretical reviews all contribute to the need for ensuring heart
health in early adulthood, before risk factors have affected lifestyle behaviors.
Along with numerous overviews of knowledge on cardiovascular disease itself, as well as
analyses of risk factors that contribute to its prevalence, there have come numerous case and
cross-sectional experimental studies presenting similar data. These studies have utilized testing
methods and past statistical data to provide concurring evidence for little improvement in heart
attack symptom awareness levels across all age and ethnic groups.8,9 Two statistical studies in
particular recognized lower levels of heart knowledge in the male population as well as those
with lower educational attainment.8,10 These physical and demographical characteristics further
explain the target population epidemiologically and provide evidence for the audience most
affected. The most unique reference also utilized past statistical data to show the effect of
various risk factors on heart health, ranging from conditions/diseases to family history.9 This
grand overview of data may be the strongest reference in analyzing the specificities of heart
health risk factors and characteristics of the effected populations. Its extensive explanations are
comparable to all other references presented in this literature review as heart health continues to
be an educational and awareness need that must be met. The contributions of this highly merited
data summary fosters application by a wide array of physicians, policy makers and public health
advocates. While this summary of numerous statistical studies presents extensive numerical data

on heart disease cost, medical procedures and quality measures, it also highlights the role of risk
factors (e.g. obesity, smoking, nutrition, physical activity, etc.), as discussed in the previous
studies, and explains the benefits that behavior-change initiatives in cardiovascular health
education can have within our communities.
Summary and Conclusions
As stated in the 2008 MMWR, half of all cardiac deaths occur almost immediately before
the patient may even make it to proper hospital care.4 The 2011 cardiology analysis publication
supportively showed no improvement in awareness of heart attack symptoms during the
timeframe under study.8 Furthermore, a 2013 heart disease statistics update significantly showed
again a lack of heart attack awareness and what emergency responses should look like.9 The
common themes throughout this literature have continued to highlight the most relevant need for
promoting even more educational initiatives that focus on identifying and responding to a heart
attack. Evidence in support of advanced approaches to utilize behavior rehearsals and roleplaying contribute even more to the need of this health communication program.3 All references
detail future research should focus on risk factor management, specific population targets, and
increasing educational promotion; all components of the Take It To Heart initiative.
Throughout this literature analysis, all conclusions remained the same and expressed the
need for more vigorous heart care awareness, identified risk factors to be acted upon and
presented ideas for future educational application. No major differences in the conclusions of
these studies were seen. One slight difference may be in the emphasized focus placed on
educational recommendations. For example, some studies believed increasing educational
programs will enhance awareness of heart attack symptoms and care, whereas other studies
believe this was not enough and that practiced behavior must be a component in achieving

retainment, confidence and adoption of heart response behaviors.3 More creative strategies are
believed to help advance this deeper learning and retainment of program material and thus
present an avenue for future research.3 These rehearsals will not only provide the appropriate
information, it will also address the emotional and social needs of witnessing and responding to
such a health concern.
In conclusion, these research findings greatly relate to the Take It To Heart initiative, in
that, awareness of heart attack symptoms and proper response is stressed throughout the program
planning process. Activities that will allow role-playing, or perhaps motivational speakers of
past heart attack survivors or witnesses, will touch the emotional struggle these younger adults
may face in such threatening situations as well as instill confidence and a sense of responsibility
in responding when needed. By targeting young adults who have low educational backgrounds,
a strong learning community can be created between participants and produced compassion can
allow for greater advocacy of heart health. Overall, these research findings connect strongly to
my planned intervention as awareness of heart health will be increased in the young adult
population by methods involving both knowledge attainment and behavior transformations.

1. Rubin JB, Borden WB. Coronary heart disease in young adults. Curr Atheroscler Rep.
2012;14(1):140-149. doi:10.1007/s11883-012-0226-3.
2. CDC Staff. Vital Signs: Avoidable deaths from heart disease, stroke, and hypertensive
disease united states, 2001-2010. Center for Disease Control and Prevention MMWR.
2013;62(35):721-727. doi:
mm6235a4.htm?s_cid=mm6235a4_w. Accessed November 10, 2015.
3. Crumlish CM. Magel CT. Patient education on heart attack response: Is rehearsal the
critical factor in knowledge retention? Research for Practice. 2011;20(6):310-317.
accountid=12085. Accessed November 10, 2015.
4. CDC Staff. Disparities in adult awareness of heart attack warning signs and symptoms --14 states, 2005. Center for Disease Control and Prevention MMWR. 2008;50(7):175-179.
doi: Accessed
November 10, 2015.
5. Chung RJ, Touloumtzis C, Gooding H. Staying young at heart: Cardiovascular disease
prevention in adolescents and young adults. Curr Treat Options Cardio Med.
2015;17(61):1-15. doi:10.1007/s11936-015-0414-x.
6. Benjamin I, Brown N, Burke G, et al. American heart association cardiovascular genomephenome study. Circulation. 2014;131(1):1-13. doi:10.1161/CIRCULATIONAHA.114.
7. Kuklina EV, Yoon PW, Keenan NL. Prevalence of coronary heart disease risk factors and
screening for high h cholesterol levels among young adults, united states, 1999-2006.
Analysis of Family Medicine. 2010;8(4):327-333. doi:10.1370/afm.1137.
8. Fang J, Gillespie C, Keenan NL, Greenlund KJ. Awareness of heart attack symptoms
among us adults in 2007, and changes in awareness from 2001 to 2007. Future Cardiol.
2011;7(3):311-320. doi:10.2217/FCA.10.111.
9. Go AS, Mozaaffarian D, Roger VL, et al. Heart disease and stroke statistics 2013
update. Circulation. 2013;127(1):e6-e245. doi:10.1161/CIR.0b013e31828124ad.
10. Swanoski MT, Lutfiyya MN, Amaro ML, Akers MF, Huot KL. Knowledge of heart attack
and stroke symptomology: a cross-sectional comparison of rural and non-rural us adults.
BMC Public Health. 2012;12(283):1-8. doi: