A 1-day point-prevalence study was conducted in our 141-bed tertiary cardiac care hospital in order to determine our patients' and their significant others' level of understanding of cardiac risk factors in general and of the patients' personal cardiac risk factors. There were 3 parts to the study: patient interviews, significant other (SO) interviews, and an audit of the participating patients' charts. Of the 87 patients who were able to participate, 71 completed the interviews as did 53 significant others. From recall, only 14 patients and 11 significant others were able to define what a cardiac risk factor was ("Habits or factors that contribute to heart disease") and they were unable to identify many general risk factors. However, when given a recognition task where cardiac risk factors were interspersed with sham factors, the overall mean general knowledge score was 13.6 for patients and 13.9 for significant others out of 16. The correlation between the patients' understanding of their cardiac risk factors and the significant others' understanding of them was reasonably good (r = 0.58, P < .0001), as was the correlation between the SOs' understanding and the charts (r = 0.58, P < .0001). There was less agreement between the patients' understanding and the chart documentation of cardiac risk factors (r = 0.36, P < .01). The findings of this study have implications for patient teaching as well as for documentation of cardiac risk factors.
Coronary artery disease (CAD) remains the leading cause of morbidity and mortality in Canada, 1 the United States, 2 and Europe. 3 The Canada Heart Health surveys (1985-1990) revealed that 41% of men and 33% of women aged 18 to 74 years had 2 or more of the major cardiac risk factors (smoking, high blood pressure, elevated cholesterol, physical inactivity, or obesity). 4 These surveys focused on modifiable risk factors-risk determinants that may be modified by intervention believed to reduce the probability of specific outcomes, 5 such as mortality and morbidity. Some studies have shown that changes in lifestyle to modify these risk factors can produce a reduction in patient mortality, a reduced rate of disease progression, and occasionally even regression of atherosclerotic lesions. 6,7 Mortality from ischemic heart disease in North America has been in decline since the 1960s. Hunink et al 8 estimate that 25% of the decline in this mortality in the United States between 1980 and 1990 was due to primary prevention, 29% due to secondary prevention, and 43% due to improvements in treatment. Other nonmodifiable cardiac risk factors include age, gender, and family history of heart disease. 1,2,3
There is some evidence that the awareness of cardiac risk factors in the general population has improved over the last 2 decades. Zerwic et al 9 cite the difference in risk factor knowledge between the study by Shekelle and Liu 10 reported in 1978 where more than half of the 617 subjects could not name any of the risk factors for heart attacks and the study by Folsom et al 11 reported in 1988 where 70% of the adults correctly identified at least 1 of the 3 main modifiable risk factors (smoking, high blood pressure, and high cholesterol or fat in the diet). Zerwic et al asked 105 patients, hospitalized for myocardial infarction or for coronary angiography with the diagnosis of coronary artery disease, open-ended questions regarding cardiac risk factors. They found that 79% of the patients named at least 1 of 3 modifiable risk factors (smoking, hypertension, elevated cholesterol) but only 7% identified all 3.
The Clinical Practice Group at the University of Ottawa Heart Institute, a 141-bed regional cardiac care hospital, identified the understanding of cardiac risk factors in the hospital patient population as a research priority. As a result, a 1-day point-prevalence study was conducted during a 12-hour period midweek. All willing and able in-hospital patients and their significant others were interviewed. Audits of the participating patients' charts were done in the 2-month period following the day of interviews.