NURSES’ AWARENESS OF THE EARLY SIGNS AND SYMPTOMS OF ACUTE CORONARY SYNDROME AT A TERTIARY CARE SETTING IN PAKISTAN: A DESCRIPTIVE CROSS-SECTIONAL STUDY

Abstract

Background: Acute coronary syndrome (ACS) is a leading cause of morbidity and mortality worldwide, and its burden is rising disproportionately in low- and middle-income countries. Because nurses are frequently the first clinicians to assess and triage patients presenting with cardiac symptoms, their ability to recognise early and atypical presentations of ACS is a critical determinant of timely intervention and survival. This study assessed nurses’ awareness of the early signs and symptoms of ACS at a tertiary care setting and identified the demographic and professional factors associated with their level of knowledge.

Methods: A descriptive, quantitative cross-sectional study was conducted among 227 registered nurses working in the emergency, cardiology and general medical wards of tertiary care teaching hospitals affiliated with LUMHS in Hyderabad/Jamshoro, Sindh, Pakistan. Participants were recruited using non-probability convenience sampling, and the sample size was derived from the single-population-proportion formula. Data were collected with a structured questionnaire based on the American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines, covering demographic characteristics and knowledge of the definition, risk factors, symptomatology, diagnostic evaluation and initial management of ACS. Knowledge was classified as good (≥75%), moderate (50–74%) or poor (<50%). Data were analysed in SPSS version 26 using descriptive statistics and the chi-square test, with p ≤ 0.05 taken as statistically significant.

Results: Of the 227 participants, 133 (58.6%) demonstrated moderate knowledge of ACS, 55 (24.2%) demonstrated good knowledge and 39 (17.2%) demonstrated poor knowledge. Knowledge level was significantly associated with educational qualification (p = 0.003), years of clinical experience (p = 0.001), working department (p = 0.021) and prior cardiac training (p < 0.001). Nurses with higher qualifications, greater clinical experience, cardiology placement and previous cardiac training achieved higher knowledge scores. Notably, 138 (60.8%) of participants had never received any formal cardiac training.

Conclusion: The majority of nurses possessed only moderate knowledge of ACS, with persistent gaps in the recognition of atypical presentations and early management priorities. Structured, guideline-concordant continuing education and mandatory in-service cardiac training—particularly for staff outside dedicated cardiac units—are needed to strengthen early recognition, reduce prehospital and in-hospital delay, and improve outcomes for patients with ACS.