Awareness and responses towards the signs symptoms of heart attack and stroke among the lay public of Kuantan, Pahang, Malaysia

Abstract

Coronary heart disease (CHD) and stroke are the major causes of mortality in Malaysia. According to the WHO, the mortality rate of CHD within Malaysia is increasing and was responsible for 23.10% of total deaths in 2014. The high rate of mortality due to heart attack and stroke is attributed to lack of awareness towards their signs and symptoms. Therefore, this study aimed to assess the awareness and response towards signs, symptoms and risk factors of HA and stroke among the general population at Kuantan, Pahang, Malaysia. A cross-sectional study was conducted via structured questionnaire survey among 393 participants in Kuantan city who were between 18-64 years of age. Majority of the respondents recognised chest pain as heart attack symptoms (HAS) followed by 68.1% sudden shortness of breath. Only 35.6% of respondents reported suitable action towards HAS. About 81.9% knew at least one HAS while 10% of them did not know any HAS. Approximately 11.5% of participants identified all five HAS and 5.6% of participants recognised all the five HAS and appropriate action (calling an ambulance). Multivariable logistic regression showed that single participants were more aware of all 5 HAS than other marital statuses (p=0.023, OR=0.023, 95% Cl=0.001-0.594). Malay participants were more likely to recognise all the 5 HAS than other race (p=0.004, OR=0.376, 95% Cl=0.193-0.773). Respondents with family history of HA, those who had received information about HA and those who were aware that HA needs urgent treatment showed more awareness on all 5 HAS than others without those conditions (p=0.055, OR=2.206, 95% Cl=0.983-4.949), (p=0.002, OR= 7.540, 95% Cl=2.0337-27.914), (p=0.01, OR= 0.17, 95%=0.044-0.710), respectively. Furthermore, the majority of individuals recognised smoking as risk factors of heart attack (RFOHA), while 91.2% of them recognised at least one RFOHA and 5.6% of individuals identified all modifiable risk factors. With regards to stroke, the majority of participants (78.6%) recognised sudden numbness or weakness of the face, arm or leg as symptoms of a stroke (SOS), followed by 74.6% of them who identified sudden trouble walking dizziness, loss of balance as SOS. Only 29.8% of respondents were aware of appropriate action towards signs and symptoms of a stroke by calling an ambulance. Approximately 88.8% of individuals classified at least one SOS while 11% of them did not recognize any SOS. Moreover, 27.5% of the participants were aware of all five SOS, while 9.4% of them identified all five SOS and appropriate action. Additionally, majority of the respondents (69.2%) were aware of hypertension as stroke risk factors (SRF) and 89.2% of those identified at least one modifiable stroke risk factors (MSRF). About 9.2% of them know all MSRF. Multivariable logistic regression showed that participants aged 18-45 years were more likely to be aware of all SOS (p=0.01, OR=0.282, 95% Cl=0.083-0.963). Hypertensive participants were more likely to be aware of all SOS (p=0.01, OR=0.129, 95% Cl=0.025-0.673). The awareness and action towards HAS, SOS and its risk factors among the general public in Kuantan were poor. Participants with high education and income represented better awareness toward HAS, SOS and its risk factors than those with low level of education and income. The awareness of HAS, SOS and its risk factors is important to reduce pre-hospital delay and mortality. Educational intervention is, thus, recommended to raise the awareness of HAS and SOS as well as to reduce the mortality due to HA and stroke.