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Low level of knowledge of heart attack symptoms and inappropriate anticipated treatment-seeking behaviour among older Chinese: a cross-sectional survey
  1. Pui Hing Chau1,
  2. Gordon Moe2,
  3. Siu Yin Lee3,
  4. Jean Woo4,
  5. Angela Y M Leung5,
  6. Chi-Ming Chow2,
  7. Cecilia Kong1,
  8. Wing Tung Lo1,
  9. Ming Hay Yuen1,
  10. Julie Zerwic6
  1. 1 School of Nursing, The University of Hong Kong, Hong Kong, China
  2. 2 Department of Medicine, University of Toronto, Toronto, Canada
  3. 3 Department of Health, Elderly Health Service, Hong Kong, China
  4. 4 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
  5. 5 Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
  6. 6 College of Nursing, University of Iowa, Iowa City, Iowa, USA
  1. Correspondence to Dr Pui Hing Chau, School of Nursing, The University of Hong Kong, Hong Kong, China; phchau{at}


Background Prehospital delay of acute myocardial infarction (AMI) is common globally, and Hong Kong—home of a rapidly ageing Chinese population—is not an exception. Seeking emergency medical care promptly is important for patients. Treatment-seeking behaviours have been shown to be associated with knowledge of AMI symptoms and specific cultural beliefs. This study aimed to assess the level of knowledge of AMI symptoms and expected treatment-seeking behaviour among older Chinese in Hong Kong.

Methods A cross-sectional population-based survey was conducted at the Elderly Health Centres in Hong Kong from March to September 2016. Face-to-face interviews were conducted with a structured questionnaire based on previous studies and local adaptations.

Results Among 1804 people aged 65 years and above who completed the questionnaire, chest pain (80.2%), palpitations (75.8%) and fainting (71.9%) were the major symptoms recognised as AMI related. Meanwhile, stomach ache (46.9%), coughing (45.4%) and neck pain (40.8%) were recognised as not AMI related. The mean expected discomfort intensity during AMI onset was 7.7 out of 10 (SD=2.1). Regarding the expected treatment-seeking behaviour, seeking non-emergent medical care was the most popular action when AMI symptoms emerged during the day, without chest pain or with lower discomfort intensity, whereas calling an ambulance was the most common option when AMI symptoms emerged at night or with high discomfort intensity.

Conclusions To minimise delays in seeking treatment, future health education should focus on increasing the public knowledge of AMI symptoms and the need to call an ambulance during an emergency.

  • elderly
  • health behaviour
  • ischaemic heart disease

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  • Contributors All authors were involved in the planning of the study, implementation of study, writing and approving the manuscript. PHC, WTL and MHY were involved in data analyses as well. PHC, GM, SYL, JW, AYML, CMC and JZ were involved in interpretation of results as well.

  • Funding This study was supported by the Early Career Scheme (no. 27105415) of the University Grants Committee, Hong Kong.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical approvals were obtained from Institutional Review Boards of the University of Hong Kong/Hospital Authority Hong Kong West Cluster and the Department of Health of Hong Kong Special Administrative Region.

  • Provenance and peer review Not commissioned; externally peer reviewed.