Do Australians need constant reminding of what a heart attack looks like? It seems so.

A new study from Monash University found that one in five adults in Australia “can’t name any heart attack symptoms”.

Incredibly, only around half report chest pain as a symptom.

Women’s symptoms tend to be much subtler, including nausea and vomiting. Even when awareness is high, less than 10 per cent of people will recognise these as symptoms.

Hence, women are more likely to get caught out by a heart attack than men.

What’s going on?

Between 2010 and 2013, the Heart Foundation ran a television campaign called Warning Signs.

One of these ads featured a bluish-looking man, wearing electrodes on his chest, who was in fact a ghost.

Lamenting the fact that he hadn’t recognised heart-attack symptoms and was now dead, the blue man was a warning to us all.

A less confronting ad was designed to empower people to call an ambulance if they suspected a heart attack was in play.

Success!

A couple of subsequent studies – see here and here  – found that the campaign had boosted public awareness.

Even better, as hoped, more people were confident enough to identify symptoms and take action by calling an ambulance or presenting their stricken loved one to a hospital.

But the latest study – where 101,936 Australian adults were surveyed – found that “there was a significant downward trend in each year following the campaign period for (knowing) most symptoms”.

Conversely, “the inability to name any heart attack symptom increased”.

Things to keep in mind

Respondents who couldn’t name a heart-attack symptom were more likely to be “younger, male, [and] have less than 12 years of education”.

People who identified as Aboriginal and/or Torres Strait Islander also were more likely to not know that chest pain was a symptom of heart attack.

As were people who “speak a language other than English at home and have no cardiovascular risk factors”.

There is information published by the Heart Foundation for people speaking Hindi, Vietnamese, Arabic and Punjabi. This is helpful only to those aware of the foundation and its website.

However, a new campaign by the Heart Foundation, Heart Matters, is “delivering free education sessions in some high-risk regions”.

The Heart Matters campaign is a no-nonsense education drive. To work, it will need a lot of energy and successful outreach strategies.

It doesn’t have the visceral grunt that made some campaigns controversial.

How successful was the campaign?

In 2017, a study led by Associate Professor Janet Bray (lead author of the new report) showed some great success by the Warning Signs campaign featuring the forlorn blue ghost.

But it also showed much need for improvement in creating a message that sticks. It also showed broad ignorance of many symptoms.

Of the 57,898 Australian surveyed, less than a quarter (23 per cent) “recalled seeing or hearing the campaign advertising”.

Those who were aware of the campaign were more likely to correctly name symptoms of heart attack than those who didn’t:

Chest pain: 67 per cent versus 63 per cent.

Chest tightness: 19 per cent versus 14 per cent.

Jaw pain: 15 per cent versus 8 per cent.

Shortness of breath : 45 per cent versus 37 per cent.

Nausea or vomiting: 8 per cent versus 6 per cent.

Sweating or clamminess: 14 per cent versus 10 per cent.

The big winner

The real winner of the campaign was the extent to which it gave people a “sense of confidence to act if they experienced symptoms of heart attack” – 66 per cent versus 50 per cent.

And to call an ambulance – 86 per cent versus 75 per cent.

Nausea or vomiting are among symptoms more commonly found in women. The low rate of recognition (8 per cent!) is understandable, given that nausea can arise from eating an old sandwich.

But it does throw down a challenge: The risks for women need to be more widely known and acted upon.

I put this in an email to Dr Bray who replied:

“Yes, women can experience different symptoms and we are trying to improve awareness of this. In the Heart Matters community trial we are currently running we are able to emphasise this depending on the audience.”