Sultanate of Oman

Ministry of health
Oman College of Health Science
Bachelor of Science in Nursing Program
Muscat Branch

Awareness Of Heart Attack Among

Adults Age 18-45 Years Of Age In
.Muscat Region

Students Names .Reg No SN

Al Ghaliya Hamdan Alkalbani 960 1

Mariya Yousuf Albalushi 1011 2

Anfal Dur Mohammed Albalushi 966 3

Fida khalid Ali alruwaishdi 984 4

Shahad Hamood Alamri 1047 5

Wisal waleed alsiyabi 1063 6

Rawan juma alabri 1035 7

Thuraiya Sami Khalaf Al-Saidi 1059 8

Hafidha Hafidh Salim Alwahaibi 996 9

Riham Khamis Gharib Al Rahbi 1041 10

 Tasnim Khalid Humaid Al Abri 1056 11

Shahad said almoharbi 1053 12

Alsafaa Salim Al-Jardani 963 13

Nawf Ahmed Al-Hadi 1026 14

February 6, 2023

Supervised by: Dr. Amal Al Ghassani

Introduction and Background

Heart attacks are considered one of the leading causes of death worldwide. An
estimated 17.9 million people died of cardiovascular disease in 2019, accounting for 32% of
all global deaths. 85% of these deaths were due to heart attacks and strokes. The global
annual number of deaths from heart and circulatory diseases is expected to rise to more than
).…,……(.23 million by 2030 and more than 34 million by 2060

Heart attack is a common name of myocardial infarction. It occurs when the flow of
oxygen-rich blood is suddenly blocked in one or more of the coronary arteries that supply the
heart muscle, and part of the heart muscle cannot get enough oxygen. If blood flow is not
quickly restored, a heart attack can cause permanent damage to the heart and death.Therefore,
even the minor heart attack symptoms must not be ignored because immediate treatment can
.)-------,--------( reduce heart damage and save lives

There are many complications associated with heart attacks include: Arrhythmias,
(abnormal heart rhythms), hHeart failure, hHeart valve problems, sSudden cardiac arrest,
dDepression and anxiety (-------,---------). Some mMechanical complications of a heart attack
include, such as a ventricular septal defect or free wall rupture, which is . These are more
likely to happen with delayed treatment of a heart attack. Many health conditions such as
diabetes, high blood pressure, lifestyle, age and family history can increase the risk of heart
disease and heart attack. Most cardiovascular diseases can be prevented by addressing
.behavioral risk factors such as tobacco use, unhealthy diet, obesity, and physical inactivity

According to a research presented at the 68th Annual Scientific Session of the American
College of Cardiology, hHeart attacks not only occurs for the elderlyolder adults but also
as well as for adults, as studies reveal that heart attacks affect those who are under the age
of 40, according to research presented at the 68th Annual Scientific Session of the American
College of Cardiology. The percentage of young adults who suffer a from heart attacks
increased by 2% in cent each year for in the past ten years (------,--------). Increasing
people's awareness is one of the most important roles in reducing heart attacks for
different age groups. Most cardiovascular diseases can be prevented by addressing
behavioral risk factors such as tobacco use, unhealthy diet, obesity, and physical inactivity.
Blankstein (--year??) said that: ''Many people believe that a heart attack is doomed to
occur, but the vast majority can be prevented through early detection of the disease,
.aggressive changes in lifestyle and management of other risk factors'' (----page #)

Statistics indicated that hHeart attacks, which increase in the winter season
compared to the rest of the year, are the leading cause of death for about 18 million
people each year, accounting for 31% of all deaths. Many acute heart attacks typically
happen between five and nine in the morning because of the biological clock in the
human body, when levels of the hormones cortisone and adrenaline are at their highest.
[Yousef Salim., 2022]

Worldwide, the cases of heart attacks are increasing especially after the COVID-
19 Pandemic and according to the Researchers discovered that overall heart attacks
increased for all age groups since the onset of the pandemic by 14% percent. By the
second year of the pandemic in [2022], heart attacks for the age group of 45-64 age group
increased by 19.6% and f13.7% for the age group of or the 65 and older group had
increased by 13.7%. However, it was the youngest age group [25-44 ] that had the highest
increase of nearly 30%.[Harjo-Livingston, S., 2023]

In Oman, Nowadays, heart attack is growing to become a huge problem in Oman

especially among young adults. and this approved by the Senior Consultant Cardiologist
at the Sultan Qaboos University- Dr.????? stated , who said that according to international
data, the number of people under the age of 40 who have a heart attack has increased by 2%
annually over the past ten years. Thisthe rising statistics of heart attackse is attributed to
modern lifestyle changes and an increase in idle behavior, particularly since the start of
the curfew and closures caused by the Corona pandemic. and it comes at the top of the list
ofMajore risk factors that can increase the chances of a heart attack in young people;
include sSmoking and excessive use of tobacco, high cholesterol levels, diabetes mellitus,
in addition to a sedentary lifestyle, poor diet, stress and depression, family history or
.)--------,---------( genetic risk, obesity and high BMI levels, drug use

Problem statement and it's significancet

According to a new study published in NHS website, 2022, a heart attack

(myocardial infarction, or MI) is a critical medical emergency in which the blood supply to
the heart is suddenly interrupted, typically by a blood clot. (NHS website, 2022). Heart
attack symptoms can include chest pain or discomfort, as well as pain or discomfort in the
arms, left shoulder, elbows, jaw, or back. [WHO,2021]

Heart attack reports among adults between the ages of 18 and 20 have increased
over the course of the last few years, reflecting an increase in the occurrence. Global
 statistics indicates that during the past ten years, the number of adults under the age of
40 who experience a heart attack has increased by 2% annually. Additionally, cardiologists
at the Cleveland Clinic Hospital in the United States said that there was an urgent need to
increase awareness of heart attacks in the region. The Gulf nations were the location of
the Cleveland Clinic survey. The two most common signs of a heart attack are "shortness
of breath" and "a sense of pressure, squeezing, heaviness, or pain in the center of the
chest. "More than 70% of the survey participants, in just two countries, were able to
correctly identify chest pain as a symptom of a heart attack; aAnd that in Bahrain by 74%
and in Oman by 73%. [Kennisgeving Voor Omleiding, 2018, p.????]

Additionally, doctors in the United Arab Emirates have expressed concern about a
surge in the number of young individuals suffering from cardiovascular illness, with half of
those affected by heart attacks under the age of 50. It turns out that cardiovascular
disease (CVD) accounts for 40% of all deaths in the United Arab Emirates and is a major
cause of death globally. [Al Arabiya English, 2021]

:Purpose

This project aims to increase the awareness of the Omani community at Muscat
govornonate awareness regarding heart attacks symptoms, and their related complications
.and consequencesand response

:Objectives

To Assess the level of awareness about heart attack »

.To minimize risk factors of a heart attack »
.To prevent complications of a heart attack »
To Educate the community about signs and symptoms of heart attack »
To improve knowledge about correct methods to respond incase of heart attacks »

Literature review

Evidence no.1
Knowledge and poor understanding factors of stroke and heart attack
.symptoms
 Chang Hoon Hanetal conduct a study about knowledge and poor understanding of
factors related to stroke and heart attack symptoms in South korea. This study aims to
assess general community awareness of heart attack and stroke symptoms and identify
the risk factors for inadequate understanding of cardiovascular illness. They gathered
information from the disease prevention and control centers in Korea. This cross-sectional
study included 228,240 people who took part in the 2017 Korean Community Health
Survey. Data on sociodemographic traits and awareness of CVD event warnings indicates
were examined . Investigating factors linked to inadequate knowledge of CVD was done
using logistic regression analysis. A two stage sampling technique is employed by the
national cross sectional KCHS. First, primary sampling units are chosen using a
probabilistic method based on the number of homes in distinct South Korean regions.
Then, in each sampling region, households are carefully chosen for examination. This two-
stage sampling procedure ensures that the results are representative of the total
population of South Korea. According to the study's findings, 19.0% of participants had
poor CVD knowledge scores, with men performing worse than women. Significant
correlations were found between a poor understanding of CVD warning signs and older
age, male gender, lower education level, lack of regular exercise, single status,
unemployment, and low socioeconomic status. Finally. The study's findings suggest that
the general South Korean population's knowledge of CVD has to be improved. Less
.knowledge of CVD has to be emphasized in public health education

Ahmed AAA, Al-Shami AM, Jamshed S, Zawiah M, Elnaem MH, Mohamed Ibrahim MI. Awareness of Citation
the Risk Factors for Heart Attack Among the General Public in Pahang, Malaysia: A Cross-Sectional Referen
Study. Risk Manag Healthc Policy. 2020 Dec 23 ce

This study aims to assess general community awareness of heart attack and stroke symptoms and Purpose
identify the risk factors for inadequate understanding of cardiovascular illness

adults (102,408 males, 125,832 females) 228,240 Sample

Cross sectional study Design

Data on sociodemographic traits and awareness of CVD event warnings indicates were examined . Measur
Investigating factors linked to inadequate knowledge of CVD was done using logistic regression ement
analysis
 According to the study's findings, 19.0% of participants had poor CVD knowledge scores, with men Results
performing worse than women. Significant correlations were found between a poor understanding
of CVD warning signs and older age, male gender, lower education level, lack of regular exercise,
single status, unemployment, and low socioeconomic status

Evidence no.2
Knowledge and Attitude of General People Towards Symptoms of Heart Attack
and the Impact of Delay Time in Riyadh, Saudi Arabia

A study was done in Riyadh ,Saudi Arabia , in 2022. The goal of the study was to evaluate
the general public's understanding of heart attack early symptoms and risk factors in
Riyadh, the capital of Saudi Arabia . By educating people and promoting a healthy
lifestyle, we can reduce the burden of the disease, as well as the mortality rate, and
prevent risk, as well as give an idea about the common presentation for patients with
cardiac events and the effect of delay time on the patients. The method used is a one
year cross sectional study from July 2021 to July 2022 conducted among 385 individuals
in Riyadh , Saudi Arabia . The most prevalent heart attack symptom, according to
participant knowledge, was chest discomfort or pressure (80.5%), followed by shortness
of breath (77%) and weakness and exhaustion (72.0%). The participants also knew that
smoking and obesity were 90.2% and 90.7%risk factors for heart attacks , respectively.
They discovered that men were more likely than women to have limited knowledge, with
46% of participants saying they "would not be at all certain" of detecting the symptoms
and indicators of a heart attack in another person and 45.7% saying "in themselves." To
summarize, this study indicates that people are not aware of the symptoms and
indicators of a heart attack. The findings of this study can be viewed as a first step in the
direction of providing fundamental knowledge on the level of awareness regarding heart
 .attacks and associated risk factors among the general population in Riyadh, Saudi Arabia

Al Harbi KM, Alluhidan WA, Almatroudi MI, Almuhanna NI, Alotaibi NM. Knowledge and Attitude of Referen
General People Towards Symptoms of Heart Attack and the Impact of Delay Time in Riyadh, Saudi ceCitati
Arabia. Cureus. 2022 Dec 20 on

This study aims to assess public understanding of heart attack symptoms and risk factors in Riyadh, Purpose
.Saudi Arabia
  .Riyadh population: Approximately 8million Sample

.Sample size: 385 completed questionnaires. Confidence level: 95%. The margin of error is 5%

Inclusion criteria / Adults older than 18 years living in Riyadh, Saudi Arabia. English or Arabic
.speakers

Exclusion criteria/ Adults with mental diseases, those under the age of 18, those residing outside of
.Riyadh, and speakers of languages other than Arabic or English

A cross-sectional study including 385 individuals was carried out in Riyadh, Saudi Arabia, from July Design
.2021 to July 2022

they used the Acute Coronary Syndrome Response Index, with additional questions added, such as Measur
risk factors of heart attack and physical activity time. An anonymous self-administered online ement
questionnaire was used to collect the data

The most prevalent heart attack symptom, according to participant knowledge, was chest Results
discomfort or pressure (80.5%), followed by shortness of breath (77%) and weakness and
exhaustion (72.0%). The participants also knew that smoking and obesity were 90.2% and
90.7%risk factors for heart attacks , respectively. They discovered that men were more likely than
women to have limited knowledge, with 46% of participants saying they "would not be at all
certain" of detecting the symptoms and indicators of a heart attack in another person and 45.7%
.saying "in themselves

Evidence no.3
Public knowledge of cardiovascular disease and response to acute cardiac
.events in three municipalities in Brazil

A study was done in Brazil in 2020. Which aims to conduct a landscape assessment of
public knowledge of cardiovascular disease risk factors and acute myocardial infarction
symptoms, cardiopulmonary resuscitation (CPR) and automated external defibrillator
(AED) awareness and training in three underserved communities. A cross-sectional,
population-based survey of non-institutionalised adults age 30 or greater was conducted
in three municipalities in Eastern Brazil. Data were analysed as survey-weighted
percentages of the sampled populations. 3035 surveys were completed. Overall, one-third
of respondents was unable to identify at least one cardiovascular disease risk factor and
25% unable to identify at least one myocardial infarction symptom. A minority of
 respondents had received training in CPR or were able to identify an AED. Low levels of
education and low socioeconomic status were consistent predictors of lower knowledge
levels of cardiovascular disease risk factors, acute coronary syndrome symptoms and CPR
and AED use. In three municipalities in Eastern Brazil, overall public knowledge of
cardiovascular disease risk factors and symptoms, as well as knowledge of appropriate
CPR and AED use was low. The findings indicate the need for interventions to improve
public knowledge and response to acute cardiovascular events in Brazil as a first step
towards improving health outcomes in this population. Significant heterogeneity in
knowledge seen across sites and socioeconomic strata indicates a need to appropriately
.target such interventions

Bartlett ES, Flor LS, Medeiros DS, Colombara DV, Johanns CK, Camargo Vaz FA, Wilson S, Duber HC. Referen
Public knowledge of cardiovascular disease and response to acute cardiac events in three ceCitati
municipalities in Brazil. Open Heart. 2020 Aug
on

To conduct a landscape assessment of public knowledge of cardiovascular disease risk factors and Purpose
acute myocardial infarction symptoms, cardiopulmonary resuscitation (CPR) and automated
.external defibrillator (AED) awareness and training in three underserved communities in Brazil

The study aimed to survey 962 individuals in PP, 1109 in PC and 1054 in VDC Sample

Cross sectional study Design

.Data were analysed as survey-weighted percentages of the sampled populations Measur

ement

According to the study's findings, one-third of respondents was unable to identify at least one Results
cardiovascular disease risk factor and 25% unable to identify at least one myocardial infarction
symptom. A minority of respondents had received training in CPR or were able to identify an AED.
Low levels of education and low socioeconomic status were consistent predictors of lower
knowledge levels of cardiovascular disease risk factors, acute coronary syndrome symptoms and
.CPR and AED use
 Evidence no.4
Public awareness of early symptoms of acute myocardial infarction among
.Saudi population

Study was done in Saudi Arabia in 2021. The main objective is to gauge the local public
awareness of the early symptoms of MI, and their knowledge of the best course of action
to be taken from the onset of symptoms. The method of research was a cross-sectional
study was conducted using google forms. Participants were randomly selected through
multiple social media platforms. The study included Saudi citizens who were 18 years or
older, with no current or prior experience in the health care field. The questionnaire
assessed the participants' awareness of 14 risk factors for CAD. The results showed A
total of 1689 participants were involved in this study. Sixty percent were females, and
29.2% were in the age group of 18–24 years. Seventy-three percent of the participants
knew the definition of heart attack, and 90% knew that chest pain is a symptom of a
heart attack. Approximately, 75% of the participants recognized that hypertension,
cigarette smoking, and high cholesterol are the risk factors of MI. In terms of
 knowledge, Al Madinah province obtained the highest score when compared with other
.regions

Basham, K., Aldubaikhi, A., Sulaiman, I., Alhaider, A., Alrasheed, A., Bahanan, F., Masuadi, E., Referen
& Alsaif, A. (2021, January 1). Directory of open access journals. Journal of Family Medicine ceCitati
and Primary Care. Retrieved February 3, 2023, from on

https://doaj.org/article/132130c89f554ac58b63e858032a303f

To gauge the local public awareness of the early symptoms of MI, and their knowledge of the best Purpose
.course of action to be taken from the onset of symptoms

The study included Saudi citizens who were 18 years or older, total of 1689 participants were Sample
.randomly selected through multiple social media platforms

Cross sectional study Design

. The data were analyzed by a survey using google form that include questionnaire Measur
ement

A total of 1689 participants were involved in this study. Sixty percent were females, and 29.2%   Results
were in the age group of 18–24 years. Seventy-three percent of the participants knew the
definition of heart attack, and 90% knew that chest pain is a symptom of a heart attack.
Approximately, 75% of the participants recognized that hypertension, cigarette smoking, and high
 .cholesterol are the risk factors of MI

Evidence no.5
Awareness of the Risk Factors for Heart Attack Among the General Public in
Pahang, Malaysia: A Cross-Sectional Study

A study was done in Pahang, Malaysia which aims to assess the awareness of risk
factors for heart attack and to identify the factors associated with the awareness of all
modifiable risk factors for heart attack in the general population. It is a cross-sectional
study, it was conducted among 393 adult individuals in Kuantan, Pahang, Malaysia.
Data collection was conducted through face-to-face interviews among the lay public
members who were 18-64 years old, excluding healthcare professionals in clinical
settings and academic settings. Statistical analysis was performed using chi-square test
and logistic regression analysis. The result was the majority of the individuals identified
smoking as a risk factor for heart attack, followed by atrial fibrillation (57.7%), heart
 disease (54.1%), and obesity (53.8%). However, diabetes (26%) was the risk factor that
was least recognized by the participants. A total of 90.6% of participants identified at
least one risk factor for heart attack, while 9.8% of the participants did not identify any
risk factors for heart attack, whereas 5.6% identified all modifiable heart attack risk
factors. Furthermore, participants aged 46-64 years old, married respondents, and
Chinese participants, those with higher educational levels, and received prior
information demonstrated great awareness of eight modifiable risk factors for heart
attack. Multivariable logistic regression presented that participants with aged 55-64,
those with family history of heart attack and individuals with dyslipidemia were factors
independently related to excellent awareness. Finally, Awareness of risk factors for
heart attack appears to be poor, where most of the respondents recognized only one
.modifiable risk factor

Ahmed AAA;Al-Shami AM;Jamshed S;Zawiah M;Elnaem MH;Mohamed Ibrahim MI; (n.d.). Referen
Awareness of the risk factors for heart attack among the general public in Pahang, ceCitati
Malaysia: A cross-sectional study. Risk management and healthcare policy. Retrieved
on
/February 3, 2023, from https://pubmed.ncbi.nlm.nih.gov/33380849

To assess the awareness of risk factors for heart attack and to identify the factors associated with   Purpose
.the awareness of all modifiable risk factors for heart attack in the general population

.adult individuals in Kuantan, Pahang, Malaysia 393 Sample

cross-sectional study Design

Data collection was conducted through face-to-face interviews among the lay public members Measur
who were 18-64 years old, excluding healthcare professionals in clinical settings and academic ement
.settings. Statistical analysis was performed using chi-square test and logistic regression analysis

The majority of the individuals identified smoking as a risk factor for heart attack, followed by Results
atrial fibrillation (57.7%), heart disease (54.1%), and obesity (53.8%). However, diabetes (26%)
was the risk factor that was least recognized by the participants. A total of 90.6% of participants
identified at least one risk factor for heart attack, while 9.8% of the participants did not identify
any risk factors for heart attack, whereas 5.6% identified all modifiable heart attack risk factors.
Furthermore, participants aged 46-64 years old, married respondents, and Chinese participants,
those with higher educational levels, and received prior information demonstrated great
awareness of eight modifiable risk factors for heart attack. Multivariable logistic regression
presented that participants with aged 55-64, those with family history of heart attack and
.individuals with dyslipidemia were factors independently related to excellent awareness

Evidence no.6
To study the Knowledge, Attitude, and Practice Toward Cardiovascular
.Diseases in the Lebanese Population
 A cross sectional study was conducted by Marc Machaalani et al, 2022, to study the
Knowledge, Attitude, and Practice Toward Cardiovascular Diseases in the Lebanese
Population. The study showed that cardiovascular diseases (CVD) are the leading cause of
death globally. Where to assessing CVD knowledge, attitude, and practice (KAP) is
necessary to spread awareness about CVD in Lebanon. The study included 921 CVD and
non-CVD subjects. A questionnaire form was used to collect data related to
patients' demographics, socioeconomic status, habits, medical and family history, KAP
towards CVD, and source of information. Data was analyzed using SPSS v.25. Where the
results showed CVD patients were significantly older than non-CVD subjects (p < 0.001).
All three KAP scores of both groups were of poor to fair levels. Both CVD knowledge and
attitude mean scores in CVD patients (26.6 ± 5.2 over 40 [66.50%] and 63.3 ± 10.2 over 85
[74.47%], respectively) were significantly higher than the ones of non-CVD subjects (23.5 ±
7.9 over 40 [58.75%] and 61.4 ± 12.4 over 85 [72.74%], respectively, p < 0.001). However,
the CVD mean practice score was significantly lower in CVD patients (6.0 ± 1.7 over 9
[66.67%]) than the one of non-CVD subjects (6.3 ± 2.2 over 9 [70.00%] p < 0.001). Mostly,
educational level (p < 0.001), governorate (p < 0.01), and smoking (p < 0.001) were
predictors of KAP CVD in both groups. As shown by the results the Lebanese
population (with CVD or non-CVD) needs targeted national campaigns about CVD
according to the identified predictors of CVD KAP to prevent and to alleviate the
.complications due to CVDs

Machaalani M, Fakhry B, Zwaideh M, Mendelek K, Mahmoud N, Hammoud T, Chahine MN. Referen

Knowledge, Attitude, and Practice Toward Cardiovascular Diseases in the Lebanese ceCitati
Population. Glob Heart. 2022 Jul 29;17(1):47. doi: 10.5334/gh.1138. PMID: 36051313; PMCID:
on
.PMC9336688

Assessing CVD knowledge, attitude, and practice (KAP) is necessary to spread awareness about Purpose
.CVD in Lebanon

Targeted 921 CVD and non-CVD subjects Sample

 Case-control analytical study  Design

questionnaire form was used to collect data related to patients' demographics, socioeconomic Measur
status, habits, medical and family history, KAP towards CVD, and source of information. Data
ement
.was analyzed using SPSS v.25

An overall limited knowledge, attitude, and practice toward CVDs, the Lebanese population Results
 (with CVD or non-CVD) needs targeted national campaigns about CVD according to the
.identified predictors of CVD KAP to prevent and to alleviate the complications due to CVDs

Evidence no.7
Variation and Disparities in Awareness of Myocardial Infarction Symptoms
.Among Adults in the United States

The study conducted in 2019 Dec 2 by Shiwani Mahajan 1, Javier Valero-Elizondo,

Rohan Khera , Nihar R Desai , Ron Blankstein , Michael J Blaha , Salim S Virani , Bita
A Kash , William A Zoghbi , Harlan M Krumholz , Khurram Nasir . The aim of the
study is to understand the variation and disparities in awareness of myocardial
infarction symptoms among adults in the United States. The Main outcomes and
measures of the study are prevalence and characteristics of individuals who were
unaware of myocardial infarction symptoms and/or chose not to call emergency medical
services in response to these symptoms. The result isAmong 25 271 individuals (13 820
women [51.6%; 95% CI, 50.8%-52.4%]; 17 910 non-Hispanic white individuals [69.9%;
95% CI, 68.2%-71.6%]; and 21 826 individuals [82.7%; 95% CI, 81.5%-83.8%] born in
the United States), 23 383 (91.8%; 95% CI, 91.0%-92.6%) considered chest pain or
discomfort a symptom of myocardial infarction; 22 158 (87.0%; 95% CI, 86.1%-87.8%)
considered shortness of breath a symptom; 22 064 (85.7%; 95% CI, 84.8%-86.5%)
considered pain or discomfort in arm a symptom; 19 760 (77.0%; 95% CI, 76.1%-
77.9%) considered feeling weak, lightheaded, or faint a symptom; and 16 567 (62.6%;
95% CI, 61.6%-63.7%) considered jaw, neck, or back pain a symptom. Overall, 14 075
adults (53.0%; 95% CI, 51.9%-54.1%) were aware of all 5 symptoms, whereas 4698
(20.3%; 95% CI, 19.4%-21.3%) were not aware of the 3 most common symptoms and
1295 (5.8%; 95% CI, 5.2%-6.4%) were not aware of any symptoms. Not being aware of
any symptoms was associated with male sex (odds ratio [OR], 1.23; 95% CI, 1.05-1.44;
P = .01), Hispanic ethnicity (OR, 1.89; 95% CI, 1.47-2.43; P < .001), not having been
born in the United States (OR, 1.85; 95% CI, 1.47-2.33; P < .001), and having a lower
education level (OR, 1.31; 95% CI, 1.09-1.58; P = .004). Among 294 non-Hispanic black
or Hispanic individuals who were not born in the United States, belonged to the low-
income or lowest-income subgroup, were uninsured, and had a lower education level, 61
(17.9%; 95% CI, 13.3%-23.6%) were not aware of any symptoms. This group had 6-
fold higher odds of not being aware of any symptoms (OR, 6.34; 95% CI, 3.92-10.26; P
 < .001) compared with individuals without these characteristics. Overall, 1130
individuals (4.5%; 95% CI, 4.0%-5.0%) chose a different response than calling
.emergency medical services in response to a myocardial infarction

Shiwani Mahajan, Javier Valero-Elizondo , Rohan Khera , Nihar R Desai , Ron Blankstein , Referen
Michael J Blaha , Salim S Virani , Bita A Kash , William A Zoghbi , Harlan M Krumholz , ceCitati
Khurram Nasir
on

To understand the variation and disparities in awareness of myocardial infarction symptoms Purpose
.among adults in the United States

.adults in the US 271 25 Sample

Cross-sectional study used data from the 2017 National Health Interview Survey among adult Design
.residents of the United States

Assessing awareness of the 5 following common myocardial infarction symptoms among Measur
different sociodemographic subgroups: chest pain or discomfort, shortness of breath, pain or
ement
discomfort in arms or shoulders, feeling weak, lightheaded, or faint, and jaw, neck, or back
pain. The response to a perceived myocardial infarction (ie, calling emergency medical services
.vs other) was also assessed

Overall, 14 075 adults (53.0%; 95% CI, 51.9%-54.1%) were aware of all 5 symptoms, whereas Results
4698 (20.3%; 95% CI, 19.4%-21.3%) were not aware of the 3 most common symptoms and
1295 (5.8%; 95% CI, 5.2%-6.4%) were not aware of any symptoms. Not being aware of any
symptoms was associated with male sex (odds ratio [OR], 1.23; 95% CI, 1.05-1.44; P = .01),
Hispanic ethnicity (OR, 1.89; 95% CI, 1.47-2.43; P < .001), not having been born in the United
States (OR, 1.85; 95% CI, 1.47-2.33; P < .001), and having a lower education level (OR, 1.31;
95% CI, 1.09-1.58; P = .004). Among 294 non-Hispanic black or Hispanic individuals who were
not born in the United States, belonged to the low-income or lowest-income subgroup, were
uninsured, and had a lower education level, 61 (17.9%; 95% CI, 13.3%-23.6%) were not aware
of any symptoms. This group had 6-fold higher odds of not being aware of any symptoms (OR,
6.34; 95% CI, 3.92-10.26; P < .001) compared with individuals without these characteristics.
Overall, 1130 individuals (4.5%; 95% CI, 4.0%-5.0%) chose a different response than calling
.emergency medical services in response to a myocardial infarction

The first evidence talks about knowledge and poor understanding factors of
stroke and heart attack symptoms in South Korea . The study's findings suggest that the
general South Korean population's knowledge of CVD has to be improved. While the
second evidence talks about knowledge and attitude of general people towards
symptoms of heart attack and the impact of delay time in Riyadh, Saudi Arabia. They
discovered that men were more likely than women to have limited knowledge. This
 study indicates that people are not aware of the symptoms and indicators of a heart
attack. Coming to Brazil, as the third evidence where about assessing knowledge
cardiovascular disease and response to acute cardiac events in three municipalities in it,
as supporting the previous evidence which the findings indicate the need for
interventions to improve public knowledge and response to acute cardiovascular events
in Brazil as a first step towards improving health outcomes in this population. As well
as the fourth the study showed the overall knowledge and awareness of CAD was
suboptimal, indicating that awareness initiatives and patient education of CAD need
more work in Saudi Arabia, especially in high-risk groups and lower education groups.
More studies are needed to identify the efficiency and population access of different
.approaches for CAD awareness
Fifth evidence was about to study the awareness of the Risk Factors for Heart Attack
Among the General Public in Pahang, Malaysia. The result shows that the majority of
the individuals identified smoking as a risk factor for heart attack, followed by atrial
fibrillation, heart disease, obesity and diabetes. Finally, Awareness of risk factors for
heart attack appears to be poor, where most of the respondents recognized only one
modifiable risk factor. Last but not least, in Lebanon we found research aims to study
the Knowledge, Attitude, and Practice Toward Cardiovascular Diseases in the Lebanese
Population. As it highly supports our studies the overall limited knowledge, attitude,
and practice toward CVDs, the Lebanese population (with CVD or non-CVD) needs
targeted national campaigns about CVD according to the identified predictors of CVD
KAP to prevent and to alleviate the complications due to CVDs. The last evidence is
about Variation and Disparities in Awareness of Myocardial Infarction Symptoms
Among Adults in the United States. The result of this study shows that Many adults in
the United States remain unaware of the symptoms of and appropriate response to a
myocardial infarction. In this study, several sociodemographic subgroups were
associated with a higher risk of not being aware. They may benefit the most from
.targeted public health initiatives

Project Plan (Methodology)

.Target group: Young adult from age 18 to 45 years old

 .Setting for Health Education: Health Centre

Method Objectives

We will Present a-lectureIncludeIntroduction about To Assess the level of

heart attack and preparing a questionnaire in Arabic awareness about heart
containing simple questions to measure the attack
awareness of young adult (18-45 years old) living in
Muscat Govern orate about heart attack and
distributing the questionnaire link on social media,
.then we analyze the results

By doing a poster showing the signs and symptoms of To Educate the community
a heart attack and making a table to differentiate about signs and symptoms
between the symptoms of a heart attack for women of heart attack
and men

Make a game in which we put several pictures, some of To minimize risk factors of
which show the risk factors for a heart attack and .a heart attack
others not, and bring some people from the audience
and make them choose the factors that they think are
related to heart attacks, then we explain that to them

We will do an interview with a nurse who has To prevent complications

experience in heart attacks, in which we will explain .of a heart attack
the complications of a heart attack in front of the
audience

We will do a role-play to show how to help someone who may be To improve knowledge »
having a heart attack about correct methods
to respond incase of
heart attacks
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