Assessing Public Awareness of Symptoms of Acute Coronary Syndrome and Awareness of Cardiopulmonary Resuscitation

INTRODUCTION

In 2020, around 523 million individuals were affected by cardiovascular disease (CVD), leading to approximately 19 million fatalities.^[1] This figure increased to 20.5 million in 2021.^[2] Ischemic heart disease (IHD) had the highest global age-standardized disability-adjusted life years rate of all diseases at 2,275.9/100,000.^[3]

Preventing IHD involves controlling manageable risk factors such as diabetes mellitus, hypertension, increased cholesterol levels, obesity, and smoking.^[4] Implementing effective population-based prevention programs could lead to a significant decrease in IHD-related illnesses and deaths.^[5]

The extent of myocardium injury depends on the time taken to get appropriate treatment after the presentation of the symptoms.^[6] Receiving prompt reperfusion within 1 hr can improve patient survival by up to 50%.^[7] The failure to recognize the symptoms of acute coronary syndrome (ACS) is responsible for the delay in seeking treatment.^[6] This delay occurs due to hesitancy to call for emergency help or seek medical care.^[8-10] Early hospitalization is critical in reducing morbidity and mortality. Therefore, creating public awareness about IHD and its risk factors is essential.^[11]

Both victims and bystanders must recognize the characteristics and symptoms of a heart attack and act promptly by contacting medical services.^[12] According to the American Heart Association, Basic Life Support (BLS) can save approximately 50,000 lives yearly in the United States alone. However, this estimate is U.S.-specific and may not directly apply globally or to the Indian context,^[13] where rates of public awareness and bystander cardiopulmonary resuscitation (CPR) remain significantly lower. CVDs pose a significant health burden worldwide and in India, it is important to emphasize the urgent need for increased public knowledge and motivation to perform BLS effectively before professional help arrives.^[13-16]

The primary objective was to assess the level of public awareness regarding the symptoms and risk factors of ACS among adults in outpatient and community settings. The secondary objective was to determine the public understanding of the recommended initial response to ACS, including CPR steps, in the same adult population.

MATERIAL AND METHODS

RESULTS

Awareness of ACS symptoms among the study participants

Individuals aged 50–64 showed higher awareness levels, with 38.9% recognizing more than five symptoms. Graduates demonstrated better awareness, with 63.0% recognizing over five symptoms compared to 37.0% of the non-graduates (P = 0.001). The most recognized symptom was chest pain (54.8%), followed by pain in the left arm or shoulder (42.9%), neck pain (29%), shortness of breath (25.9%), dizziness (23.6%), sweating (22.8%), palpitations (16%), and anxiety (14.6%). Fatigue was the least identified symptom (13.5%) [Figure 1]. In addition, 33.1% of participants were unaware of any ACS symptoms.

Close

Figure 1:

Awareness of symptoms of acute coronary syndrome among the study participants.

Export to PPT

DISCUSSION

Delayed reporting to medical facilities after the onset of ACS symptoms continues to be a serious global issue that increases the morbidity and mortality rates.^[8] In our study, a third of subjects were unaware of ACS symptoms, which is consistant with the United States and South Korean studies.^[17,18] Chest pain was the most recognized symptom, mirroring results from multiple Asian studies.^[10,17] However, Dizziness, sweating, palpitations, anxiety, and fatigue were the least recognized symptoms in the present study, as observed in the studies conducted across the world.^[12,19-21]

Male participants exhibited a greater awareness of heart attack symptoms than females in the present research. Conversely, Kim et al., and Khan et al., research revealed that females had higher knowledge of myocardial infarction symptoms than males.^[22-23] Despite this, it suggests a gender gap in health education, necessitating targeted interventions to improve awareness and response to ACS symptoms. The gender gap observed in our study may reflect cultural and societal factors in India, where men generally have greater exposure to health information through employment, social mobility, and healthcare interactions, whereas women often have limited access to preventive health education due to domestic roles and lower participation in community programs. Similar disparities in cardiovascular health awareness among Indian women have been highlighted by Prabhakaran et al.^[24] These findings underscore the need for gender-sensitive educational interventions to improve women’s cardiovascular health literacy.

There is a significant connection between education and understanding of ACS. Graduates demonstrated higher levels of knowledge in recognizing more than five ACS risk factors and symptoms than non-graduates in the present study. These findings demonstrate that higher education improves health literacy. These results suggest that health awareness programs should target less educated individuals through community programs and simplified health messages.

The participant’s awareness of ACS risk factors varied. Smoking was the most recognized risk factor, followed closely by alcohol consumption, overweight, hypertension, and stress, consistent with the Ahmed et al., and Mohammad et al., study results.^[20,25,26] However, diabetes mellitus and inadequate exercise were poorly identified. Mirroring the results from research studies in Ethiopia and Oman, and Khan et al. and Ahmed et al.^{[20,23,27-30].}In Contrast, Ramachandran et al.’s study, around two-thirds of the participants, identified diabetes as a risk factor for coronary heart disease.^[31] Many campaigns have been conducted on quitting smoking.^[30] The above results insist that thorough educational training is required to address a wide range of ACS risk factors, including less recognized ones such as diabetes and physical inactivity.

The current results revealed that males are more aware of ACS risk factors than females. In contrast, women had more awareness than men in research in Buea.^[32] This indicates that public health campaigns should adopt gender-specific strategies to better educate men and women about ACS risk factors.

In the present study, more than half of the participants said that they would take the person having ACS symptoms to consult the nearest doctor, which is consistent with the Nepalese study.^[33] Conversely, the first response to ACS symptoms was low in the study conducted in Turkey.^[34] Abdo Ahmed et al. noted that public knowledge of ACS first responses is lower in developing countries than in developed ones.^[8] These findings highlight a significant delay in initial responses to ACS, stressing the need for better public education.

Cardiac arrest is a medical emergency where early CPR can significantly improve survival and reduce neurological damage. Despite the critical role of the CPR, global public knowledge and behavior regarding CPR are often lacking. In our study, only a third of participants were aware of CPR. Furthermore, a quarter of the subjects knew the initial steps of CPR, which aligns with the results of the Varleta et al., study.^[35] Among the present research participants, older age groups (50–64 and 65–79) showed higher CPR awareness than younger groups. Contrary to this, a study in Austria by Krammel et al. found decreasing CPR knowledge and willingness to perform it with increasing age.^[32] Research carried out by Agarwal et al. in northern India revealed that the baseline knowledge level of CPR among physicians and nurses has considerably improved after resuscitation training was introduced.^[36] A similar study was conducted by Saramma et al, in South India, which showed that there was significant improvement in their knowledge, skill, and attitude. A further half of the patients agreed that it improved their communication, while above two-thirds of participants confirmed that it increased their confidence after CPR training.^[29] The observed low CPR awareness aligns with global and Indian data, highlighting limited public training and readiness. Recent initiatives, such as Pan-India CPR Awareness Week in 2025, underscore the importance of building a culture of resuscitation literacy. To strengthen CPR preparedness, structured interventions should include integrating BLS and CPR education into school and college curricula, community-based programs and workplace initiatives to improve public knowledge, confidence, and willingness to respond effectively during cardiac emergencies.

The study findings show poor awareness of CPR skills among the public and even those with previous heart disease. Critical care physicians need to make a nationwide effort to improve public awareness of CPR.

CONCLUSION

The study results revealed insufficient public awareness of ACS symptoms, risk factors, and CPR steps, particularly among females, younger adults, and non-graduates. We recommend targeted educational programs focusing on these vulnerable groups to improve early recognition and response, potentially reducing morbidity and mortality.