Differences in Myocardial Infarction and Stroke Knowledge and Awareness Among US‐ and Foreign‐Born Individuals: Potential Causes and Implications

Background Atherosclerotic cardiovascular disease, defined as nonfatal myocardial infarction (MI), coronary heart disease death, or fatal or nonfatal stroke, is the leading cause of death in the United States. MI and stroke symptom awareness and response reduce delays in hospitalization and mortality. Methods and Results We analyzed cross‐sectional data from the 2014 and 2017 National Health Interview Surveys on US‐ and foreign‐born adults from 9 regions of birth (Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, Indian subcontinent, Asia, and Southeast Asia). The outcomes were recommended MI and stroke knowledge, defined as knowing all 5 symptoms of MI or stroke, respectively, and choosing “call 9‐1‐1” as the best response. We included 63 059 participants, with a mean age 49.4 years; 54.1% were women, and 38.5% had a high school education or less. Recommended MI and stroke knowledge were highest in US‐born people. In both 2014 and 2017, MI knowledge was lowest in individuals born in Asia (23.9%±2.5% and 32.1%±3.3%, respectively), and stroke knowledge lowest for the Indian subcontinent (44.4%±2.4% and 46.0%±3.2%, respectively). Among foreign‐born adults, people from Russia and Europe had the highest prevalence of recommended MI knowledge in 2014 (37.4%±5.4%) and 2017 (43.5%±2.5%), respectively, and recommended stroke knowledge was highest in people from Europe (61.0%±2.6% and 67.2%±2.5%). Improvement in knowledge was not significant in all groups between 2014 and 2017. Conclusions These findings suggest a disparity in MI and stroke symptom awareness and response among immigrants in the United States. Culturally tailored public health education and health literacy initiatives are needed to help reduce these disparities in awareness.

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Characteristics and outcome in foreign-born vs Sweden-born patients with myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1313 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Zwackman ◽

J.-E Karlsson ◽

S Sederholm Lawesson ◽

T Jernberg ◽

M Leosdottir ◽

...

Keyword(s):

Myocardial Infarction ◽

Low Income ◽

Cox Regression ◽

County Council ◽

Nordic Countries ◽

Funding Source ◽

Foreign Born ◽

Baseline Characteristics ◽

One Year ◽

Age And Sex

Abstract Introduction Immigration is increasing in most European countries. Little is known about differences in baseline characteristics and outcome between foreign-born and native patients with myocardial infarction (MI). Purpose To investigate differences in baseline characteristics and one-year mortality after an MI, based on region of birth. Methods We included 194 498 MI patients (36% women) between 2005 and 2016 from the SWEDEHEART registry and compared them according to region of birth: Sweden (Sw, n=166020), Other Nordic countries (No, n=10856), EU countries except Nordic (EU, (n=6301), Non-EU Europe (non EU, n=4779), Asia (n=4927), Africa (n=669), S America (n=567) and N America (n=379). One-year mortality was assessed using a Cox regression model (pairwise with Swedish-born as reference) and in a second model adjusting for age and sex. Data are presented as hazard ratios (HR) with 95% confidence intervals (CI). Results There was an increased proportion of foreign-born patients over time (12.8 to 16.7%). We observed substantial differences in risk factors and comorbidity according to region of birth (lowest vs highest value) in age (mean) (58 vs 72 year, African vs Sw. born), smoking (19 vs 39%, Sw. vs Asian born), history of diabetes (20 vs 36%, African vs Sw. born), hypertension (40 vs 59%, born in African vs No.), MI (17 vs 23%, S America vs EU born) stroke (9 vs 20%, born in S American vs No.), low income (28% vs 56%, Sw. vs Asian born) and low level of education (27 vs 49%, born in Africa vs No.). One-year mortality according to region of birth was 15.4% for patients born in Sweden, 14.0% for patients born in other Nordic countries, 12.8% in EU, 9.6% for non-EU Europe, 6.3% for Asia, 8.4% for Africa, 6.7% for S America and 15.0% for N America. After adjustment for age and sex, the only significant differences were higher mortality in patients born in other Nordic countries (HR 1.1, 95% CI: 1.01–1.12), non-EU Europe (HR=1.12, 95% CI: 1.02–1.23) and Africa (HR=1.68, 95% CI: 1.29–2.19) compared to patients born in Sweden. Conclusions We observed increased rate of foreign-born MI patients, with differences in risk profile, comorbidity, education and financial resources according to region of birth, which may impact on observed differences in outcome. Equal access to care pose a challenge which may merit a more comprehensive and individualised approach to cardiac care. Future analyses should explore differences in treatment based on region of birth and potential association with outcome. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Kamprad Family for Entrepeneurship, Research and Charity; The County Council of Östergötland, Sweden; Medical Research Council of Southeast Sweden

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Abstract 17213: Myocardial Infarction and Stroke Awareness Among US and Foreign-Born Adults in the 2014 and 2017 National Health Interview Survey

Circulation ◽

10.1161/circ.142.suppl_3.17213 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ivy Mannoh ◽

Ruth Alma N Turkson Ocran ◽

Yvonne Commodore-mensah

Keyword(s):

Myocardial Infarction ◽

National Health ◽

Indian Subcontinent ◽

The United States ◽

Atherosclerotic Cardiovascular Disease ◽

Foreign Born ◽

Cross Sectional ◽

Stroke Symptom ◽

Health Interview ◽

Symptom Awareness

Background: Atherosclerotic cardiovascular disease, defined as nonfatal myocardial infarction (MI), coronary heart disease death, or fatal or nonfatal stroke, is the leading cause of death in the United States (US). MI and stroke symptom awareness reduces delays in hospitalization and mortality. We hypothesized that foreign-born persons will have lower stroke and MI symptom awareness than US-born persons. Methods: We analyzed cross-sectional data from the 2014 and 2017 National Health Interview Surveys (NHIS) on US-born and foreign-born adults from 9 regions of birth (Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, Indian subcontinent, Asia, and Southeast Asia). Our outcomes were stroke and MI symptom awareness, and the best action to take during a stroke or MI event. Awareness was defined as knowing all 5 symptoms of MI or stroke respectively, and choosing “call 911” as the best action to take in the event of an MI or stroke. Generalized linear models with Poisson distribution and a logarithmic link was used to assess disparities in awareness between foreign-born and US-born persons. We compared responses from 2014 and 2017 to assess improvement in awareness. Results: We included 63,439 participants, with mean age 38.2 years; 51% were female and 50% had less than high school education. After adjusting for age, sex, and education, we observed significant variation in MI and stroke symptom awareness and best action to take by region of birth [Table]. In comparison to US-born, foreign-born persons were less aware of MI and stroke symptoms and the best action to take. Improvement in awareness was not significant in all groups between 2014 and 2017. Conclusion: These findings suggest a disparity in MI and stroke symptom awareness among immigrants in the US. Culturally tailored public health education and health literacy initiatives are needed to help reduce these disparities in awareness.

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An electron microscopic study of the intra-myocardial lesions in cases of acute myocardial infarction

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010008328x ◽

1978 ◽

Vol 36 (2) ◽

pp. 484-485

Author(s):

Masahiro Ono ◽

Kaoru Aihara ◽

Gompachi Yajima

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Coronary Vessels ◽

Vascular Wall ◽

Vascular Changes ◽

Electron Microscopic ◽

Main Trunk ◽

Mechanical Destruction ◽

Transmission Electron ◽

Myocardial Lesions

The pathogenesis of the arteriosclerosis in the acute myocardial infarction is the matter of the extensive survey with the transmission electron microscopy in experimental and clinical materials. In the previous communication,the authors have clarified that the two types of the coronary vascular changes could exist. The first category is the case in which we had failed to observe no occlusive changes of the coronary vessels which eventually form the myocardial infarction. The next category is the case in which occlusive -thrombotic changes are observed in which the myocardial infarction will be taken placed as the final event. The authors incline to designate the former category as the non-occlusive-non thrombotic lesions. The most important findings in both cases are the “mechanical destruction of the vascular wall and imbibition of the serous component” which are most frequently observed at the proximal portion of the coronary main trunk.

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