Introduction

Cardiovascular diseases account for roughly 50% of fatalities in the United States and approximately 30% in France. An American experiences a heart attack every forty seconds. Failure to promptly recognize distressing physical symptoms like chest or back pain, nausea, excessive sweating, and breathing difficulties as potential indicators of a heart attack, and consequently delaying the urgent call for help, significantly heightens the risk of rapid death or severe long-term consequences. Reducing the interval between symptom onset and the initiation of effective treatments entails shortening the time it takes to acknowledge the urgency of the situation, adopting appropriate behaviours, arranging transportation to the relevant hospital department, and promptly receiving care upon arrival at the emergency room. It's estimated that the initial factor accounts for 75% of the time lost in this process. A meta-analysis of 100 studies from 50 countries examined people's ability to recognize or trigger physical symptoms associated with the onset of a heart attack. When presented with a list of symptoms, the majority of participants recognized chest pain or discomfort (90%), shortness of breath (50%), and pain or discomfort in the arm or shoulder (85%). However, lesser percentages recognized sweating (50%), feeling weak (70%), back pain (40%), and nausea (30%). When participants were asked open-ended questions, recognition percentages were lower overall: 80% mentioned chest pain, 60% mentioned pain in the arm or shoulder, 50% mentioned shortness of breath, and 44% mentioned sweating. This study approached the issue from a functional perspective, investigating how individuals interpret a variety of physical symptoms to form a personal belief that they might be experiencing a heart attack.

Typical symptoms

A scenario approach was employed wherein a range of lifelike scenarios were crafted depicting participants encountering various distressing physical symptoms upon waking up such as chest or back pain, sudden sweating, nausea, and shortness of breath. Participants were tasked with assessing the likelihood of experiencing a heart attack in each scenario. This experimental setup allows for investigating participants' ability to identify heart attack symptoms and understand how they incorporate this symptomatic information into an overall judgment of likelihood, potentially guiding their subsequent actions. Given the range of findings outlined earlier, it was anticipated that there would be four distinct responses to the scenarios described. The initial response anticipated was the disbelief that any combination of symptoms, no matter how severe, could indicate the onset of a heart attack. Some individuals would perceive themselves as being at minimal risk, while others would recognize a somewhat higher risk. It has been noted that people often underestimate their susceptibility to disease, and some may lack awareness of the typical symptoms of a heart attack. The second anticipated reaction was one of hesitation. This was observed in a qualitative study involving hospitalized Korean patients, where some participants struggled to pinpoint the cause of their discomfort and attributed it to other factors. Specifically, individuals experiencing intermittent or gradually worsening symptoms or those with an unusual presentation involving mild chest discomfort admitted to not realizing the seriousness of their symptoms.

Physical symptoms

\Through analyzing the responses of participants, researchers identified two distinct viewpoints. A minority (38%) associated chest pain, back pain, shortness of breath, and weakness strongly with a heart attack, while a majority (72%) only linked the first two symptoms strongly. Consequently, it was expected that some participants in the current study would perceive chest and back pain, along with other physical symptoms, as indicative of a heart attack, whereas others would only consider chest pain as such. Essentially, this study seeks not only to ascertain whether individuals recognize various physical symptoms as potential signs of a heart attack, as explored in prior research, but also to delineate the potentially differing cognitive processes through which individuals assimilate this information to form judgments about the likelihood of a heart attack. For individuals to effectively navigate unpleasant physical symptoms and make informed decisions, it's insufficient for them solely to connect individual symptoms with specific illnesses. They must also be capable of comprehensively assessing these symptoms together, integrating each manifestation into an overarching evaluation that guides timely actions. In the recent research, slightly over half of the participants demonstrated this ability adequately. Their decision-making processes closely resembled those of experts, assigning similar importance to various types of discomfort and symptoms. For instance, akin to experts, they prioritized persistent pain over transient pain and accorded greater significance to pain compared to nausea. Similarly, they adopted an additive approach in evaluating information, avoiding any tendency to downplay or disregard any symptom when assessing the probability of a heart attack.