Cardiovascular health knowledge and behavior in patient attendants at four tertiary care hospitals in Pakistan – a cause for concern

Abstract

BackgroundKnowledge about coronary heart disease (CHD) and its risk factors is an important pre-requisite for an individual to implement behavioral changes leading towards CHD prevention. There is scant data on the status of knowledge about CHD in the general population of Pakistan. The objective of this study was to assess knowledge of CHD in a broad Pakistani population and identify the factors associated with knowledge.MethodsCross sectional study was carried out at four tertiary care hospitals in Pakistan using convenience sampling. Standard questionnaire was used to interview 792 patient attendants (persons accompanying patients). Knowledge was computed as a continuous variable based on correct answers to fifteen questions. Multivariable linear regression was conducted to determine the factors independently associated with knowledge.ResultsThe mean age was 38.1 (±13) years. 27.1% had received no formal education. The median knowledge score was 3.0 out of a possible maximum of 15. Only 14% were able to correctly describe CHD as a condition involving limitation in blood flow to the heart. Majority of respondents could identify only up to two risk factors for CHD. Most commonly identified risk factors were stress (43.4%), dietary fat (39.1%), smoking (31.9%) and lack of exercise (17.4%). About 20% were not able to identify even a single risk factor for CHD. Factors significantly associated with knowledge included age (p = 0.023), income (p < 0.001), education level (p < 0.001), residence (p < 0.001), a family history of CHD (p < 0.001) and a past history of diabetes (p = 0.004). Preventive practices were significantly lacking; 35%, 65.3% and 84.6% had never undergone assessment of blood pressure, glucose or cholesterol respectively. Only a minority felt that they would modify their diet, stop smoking or start exercising if a family member was to develop CHD.ConclusionThis is the first study assessing the state of CHD knowledge in a relatively diverse non-patient population in Pakistan. There are striking gaps in knowledge about CHD, its risk factors and symptoms. These translate to inadequate preventive behavior patterns. Educational programs are urgently required to improve the level of understanding of CHD in the Pakistani population.

Degree and correlates of cardiac knowledge and awareness among cardiac inpatients

“…Results showed that those with less than high school education and with an annual income of less than $50,000 CAD had significantly lower CHD knowledge. This is consistent with what has been reported in the literature [7,17,19,23,26,29], whereby those with advanced education and income were more knowledgeable about CHD. These findings are problematic because low SES is strongly associated with an increased prevalence of CHD risk factors [4,53,54] and with greater morbidity and mortality among CHD patients [48,49,55,56].…”

“…As well, contrary to previous studies which found that South Asians are significantly lacking in CHD knowledge [17,29,50], we were unable to find a difference between South Asians and non-South Asians. The lack of a significant effect may have been due to insufficient power considering the small number of South Asian patients in this study, or due to the fact that other studies examined South Asians alone and did not make comparisons to other ethnic groups.…”

“…One other Canadian study assessing risk factor knowledge among a small sample (N=71) of cardiac in-patients [19] reported a mean knowledge score of 85% correct, compared to the 72% broader knowledge score in our patient sample. Other studies have suggested a significant lack of CHD knowledge among the general population [50] and in patients themselves [17,20,29]. Our results suggest that cardiac inpatients do have general knowledge regarding their condition, but that continued efforts are necessary to fully educate patients, particularly with regard to diagnostic tests, treatment of symptoms and interventional procedures such as PCI and coronary bypass surgery.…”

“…For example, those who have undergone a percutaneous coronary intervention (PCI) may be less likely to make lifestyle modifications because they feel "cured" from the relatively unintrusive intervention [28], putting them at a higher risk of further CHD progression. However, there are inconsistent findings regarding the degree and correlates of knowledge [17,19,20,29].…”

Nivel de conocimiento sobre factores de riesgo cardiovascular en una comunidad de Naguanagua, Venezuela

“…En una investigación realizada en Pakistán los individuos estudiados identificaron como factores de riesgo al estrés, HTA, sobrepeso y sedentarismo (26), mientras que en el presente trabajo los factores identificados con mayor frecuencia fueron la grasa dietaria y el hábito tabáquico, en semejanza a lo reportado en Canadá y en otro estudio paquistaní (6,24). Dicho patrón de conocimiento pudiera deberse a que las campañas de prevención para ECV profundizan en la erradicación del hábito tabáquico y en la disminución del consumo de grasas saturadas.…”