Survey Shows Gaping Silences Around Heart Health That We Must Fill

Nearly half of millennials don’t know what to ask their doctor

By Steven Nissen, MD

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A Cleveland Clinic survey of 1,000 U.S. adults conducted late last year to gauge public knowledge of heart health information was revealing: Large percentages of adults confuse heart attack and stroke symptoms, do not know how to respond to a heart attack and do not know how to perform CPR properly or at all.

More surprising, however, was how few of those surveyed had basic knowledge of their own heart health: About half (49 percent) said they knew very little or nothing at all about their personal heart health. Even more — 59 percent — said they knew little or nothing about heart health in general.

Knowledge of one’s own heart health varied by age group, with baby boomers knowing more than millennials. While this age effect isn’t surprising, millennials’ level of disinterest was an eye-opener: 37 percent of them said they would rather spend time on Instagram than learn about heart health.

Lack of knowledge begets lack of knowledge

Those of us who spend our lives seeing the ramifications of ignorance about heart disease risk factors may wonder how it is that so many people don’t know or care to know about a disease that has a 1 in 3 chance of killing them.

Answers to other questions from the survey may hold the key: Patients are waiting for us to educate them:

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  • Almost 9 in 10 respondents (87 percent) said they expect their doctor to tell them about their heart health.
  • Many fewer (62 percent) said they make it a point to always ask their doctor about their heart health themselves.

As expected, baby boomers are more likely to broach the issue than younger generations. And here’s where lack of knowledge begets lack of knowledge: 49 percent of millennials said they don’t know what to ask their doctor to protect themselves from heart disease.

In other words, if we don’t raise the topic, it will go undiscussed.

Starting the discussion at a younger age

By the time a patient needs a cardiologist, it’s too late to have optimal impact. Basic heart education needs to be started by general and family practitioners when patients are young and healthy. This is when we should take a careful family history to lay the foundation for a patient’s future risk of a cardiovascular event.

It’s the time to counsel patients about diet, exercise and smoking and give them an understanding of the relationship between these lifestyle factors and obesity, high blood pressure, high cholesterol levels, high blood sugar levels and diabetes. Baseline blood tests can set the stage for this important discussion, which should be raised again at every checkup.

How do we help more patients learn the symptoms of heart attack and stroke, how to respond to a heart attack or how to do CPR? We can stop passing up easy opportunities for education by putting up posters in our exam rooms and sharing patient information (online and/or printed) from groups like the American Heart Association. And the growing ranks of compelling online and multimedia patient education tools (including some from Cleveland Clinic) are increasingly able to hold their own against Instagram among even the most distractable millennials.

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Let’s be proactive and make ourselves part of the solution. We can’t make patients care about heart disease, but we sure can try to give them information that may one day save their life.

Results reported here are from a Cleveland Clinic online survey of 1,007 U.S. adults conducted in October 2017. The sample was nationally representative by age, gender, region, ethnicity, race, education and income. It had a margin of error of ±3.1 percent (95% confidence interval).

Dr. Nissen ( is Chair of Cardiovascular Medicine at Cleveland Clinic.