Elsevier

Resuscitation

Volume 71, Issue 1, October 2006, Pages 70-79
Resuscitation

Training and educational paper
Public perceptions and experiences of myocardial infarction, cardiac arrest and CPR in London

https://doi.org/10.1016/j.resuscitation.2006.03.003Get rights and content

Summary

Introduction

The lay public have limited knowledge of the symptoms of myocardial infarction (“heart attack”), and inaccurate perceptions of cardiac arrest survival rates. Levels of CPR training and willingness to intervene in cardiac emergencies are also low.

Aims

To explore public perceptions of myocardial infarction and cardiac arrest; investigate perceptions of cardiac arrest survival rates; assess levels of training and attitudes towards CPR, and explore the types of interventions considered useful for increasing rates of bystander CPR among Greater London residents.

Methods

A quantitative interview survey was conducted with 1011 Greater London residents. Eight focus groups were also conducted to explore a range of issues in greater depth and validate trends that emerged in the initial survey.

Results

Chest pain was the most commonly recognised symptom of “heart attack”. Around half of the respondents were aware that a myocardial infarction differs from a cardiac arrest, although their ability to explain this difference was limited. The majority overestimated that at least a quarter of cardiac arrest patients in London survive to hospital discharge. Few participants had received CPR training, and most were hesitant about performing the procedure on a stranger.

Conclusions

Awareness and knowledge of CPR, and reactions to cardiac emergencies, reflect relatively low levels of CPR training in London. Publicising cardiac arrest survival figures may be instrumental in prompting members of the public to train in CPR and motivating those who have been trained to intervene in a cardiac emergency.

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.

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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.

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