A self–administered questionnaire for detection of unrecognised coronary heart disease

Abstract

On an individual and a population basis, an increased incidence of coronary heart disease is associated with classical cardiovascular risk factors, but many cases occur in people not identified as at high risk. Conversely, many people at high statistical risk do not develop coronary disease. We used a questionnaire to identify unrecognised coronary heart disease in people attending large-scale health survey centres. Participants were required to report the presence and characteristics of any chest pain. Those returning responses consistent with myocardial ischaemia were offered treadmill exercise ECG tests. Over 18 months, 4070 questionnaires were returned. Of 475 respondents offered testing, 229 (198 male, 131 female) accepted. Thirty-two subjects (15 male, 17 female: a detection rate of 13.9 per cent of those assessed as likely on questionnaire, or 0.8 per cent of all respondents) had results consistent with significant coronary heart disease. Follow-up was available in 30 cases. There was no difference in classical risk-factor distribution (including multivariate risk percentiles: 42.4 (male) and 46.7 (female)) between those newly diagnosed with coronary heart disease and their community counterparts. More women than men were identified as suffering from unrecognised coronary heart disease, with a preponderance of younger women. Cost per case identified was A$l220. Screening by self-administered questionnaire is a useful and relatively cost-effective means of identifjmg unrecognised coronary heart disease. (Aust N ZJPublic Health 1997; 21: 545-7) N a population basis, an increased incidence of coronary heart disease is associated with 0 higher levels of classical cardiovascular risk factors, considered to be clinical or biochemical markers of a statistically increased likelihood of having or developing the disease.' Much coronary heart disease morbidity and mortality occurs in people not classified as at excessively high risk. This is because, at least partly, of the high proportion of the population who fall into the mild-to-moderate-risk group and to the complex multifactorial interactions involved in the development of coronary heart disease. Population screening on the basis of classical risk factors is therefore likely to miss a significant number of people who warrant further investigation Correspondence to Dr

Awareness, Perception, and Knowledge of Heart Disease Risk and Prevention Among Women in the United States

“…Other surveys have also indicated that many women are unaware that they have symptoms of early heart disease or that they possess risk factors for developing CVD. [6][7][8] Legato et al 9 reported that 44% of women in the United States surveyed believed that it was somewhat or very unlikely that they would suffer a heart attack, and 58% believed they were as likely or more likely to die of breast cancer than heart disease; yet 74% of these women rated themselves as fairly or very knowledgeable. Of those women who saw a physician regularly, 59% reported that their physician never spoke to them about heart disease, including 44% of women 60 years or older.…”