Background

According to World Health Organization (WHO), cardiovascular diseases (CVDs) are a group of disorders that include the heart or blood vessels disorders or both. It includes coronary heart disease (CHD), cerebrovascular disease, congenital heart disease, rheumatic heart disease, peripheral arterial disease, deep vein thrombosis and pulmonary embolism. An estimated 17.7 million people died from CVDs in 2015, representing 31% of all global deaths. Of these deaths, an estimated 7.4 million were due to CHD and 6.7 million were due to stroke [1]. The WHO statistics indicates that CVD related deaths are seventeen million yearly, and by the end of 2030 this number will be gradually increasing up to twenty three million [2]. In one of the study conducted by [3] highlighted that cardiovascular Diseases (CVDs) are the major cause of mortality around the globe. According to the latest available data, the mortality rate due to these diseases was about 17.7 million, accounting for 31% of all deaths worldwide in 2015.  A research was conducted on public knowledge of cardiovascular diseases and its risk factors by [4] in Kuwait, the results highlights that Respondents’ knowledge about types of CVDs, heart attack or stroke symptoms was low. Almost 60% of respondents did not know any type of CVDs. Coronary heart disease was the commonest identified type (29.0%). Two-fifths of participants were not aware of any heart attack symptoms, and the most commonly known were chest pain (50.4%) and shortness of breathe (48.0%).  A cross sectional study conducted by [5] shows that 12.6% of people recognized that being male is the risk factors of CVDs, 90% of the people realized the benefits of smoking cessation.  According to [6] that major risk factors for heart disease are dyslipidemia (96.8%), obesity(94.1%), high blood pressure(92.8%), smoking(84.4%), diabetes(82.4),age(81.8%), male gender (80.4%), lack of physical activity (73.9%), and family history (63.6%).  A study conducted in Cameroon by [7] on “population awareness of cardiovascular disease and its risk factors” the results highlights that 67.1% women had poor knowledge regarding risk factors of CVDs , 36, 63 and 45% were unaware of it [3]. Conducted a cross sectional study on Cardiovascular Disease Knowledge among Cardiac Rehabilitation Patients. The finding shows that most of the participants had a low level of knowledge about CVDs and cardiac rehabilitation (52.8%). Recently in another study conducted by [8], the results show that across nine ASEAN countries (Association of Southeast Asian Nations) among men and women, 27.5% and 16.9% respectively were overweight , 39.0% and 53.0% were with low physical activity, 6.9% and 2.5% were current tobacco users [9]. conducted a study in Malaysia shows, 88% participants knew that irregular eating pattern can cause CVD. Most of them recognized that smoking and obesity were the risk factors of CVD. 96% were agreed the exercise can prevent CVD.A study conducted in Lahore, Pakistan by [10] on knowledge, attitude and practice regarding modifiable risk factors of cardiovascular diseases among adult in rural community, shows that among the respondents 67% were having good knowledge and the response were high to “ smoking is risk factors of CVD”. The attitudes were negative. 28% of the participants were having good knowledge regarding exercise but the practices were very poor regarding risk factors of CVDs.  He aim of the study was to assess the knowledge of patients regarding risk factors of cardiovascular diseases in tertiary care hospital Peshawar, Pakistan.

Study Design: The research approach adopted for this study was Quantitative descriptive cross sectional design. It is most common study design. In this type of research study, either the entire population or a subset is selected, and from these individuals, data are collected to help answer research questions of interest.

Study Setting: The study was conducted in Private Tertiary Care Hospital Peshawar, Pakistan.

Study Population: The population of the study was admitted patients of cardiac units in Private Tertiary Care Hospital.

Sampling Technique: The sampling technique, which was used in this study, is non-probability convenience sampling technique. This technique was selected because of the availability of the patients, limited resources and constrain of the time.

Sample Size: Sample size of the study was calculated by using Rao Soft calculator. The calculated sample size was 80 with a population size 100, 95% confidence level and 5% margin of error. The population size extract from the previous month data.

Study Tool: Questionnaire was adopted from a cross sectional study on “Public Knowledge of Cardiovascular disease and its risk factors in Kuwait” by [4]. Some modifications were made accordingly. The content validity of the adopted questionnaire were established by a researcher group at Kuwait University. The questionnaire has been used in many studies and validated by many researchers, [11-14]. Questionnaire consists of three parts demographic data, medical history and knowledge regarding risk factors of CVDs. It was translated into Urdu to understand by the participants easily.

Data Collection Procedure: Study proposal was reviewed by inter institutional review committee of the Institute, and permission was granted along with all these, permission was taken from chief Nurse of the hospital and HODs of the concern departments to collect data from the patients. Data was collected through questioner which was taken at least 10-15 minutes individually. Additionally, the questionnaire was distributed among the participants. Consent was taken from each participants. Participation in the study were completely voluntary, and they were free to withdraw at any time.

Inclusion Criteria

• All admitted patients in cardiac Units.
• Patients who are willing to participate in the study
• 18 years and above.

Ethical Consideration

Permission was taken from the chief Nurse of the Hospital. Written consent was taken from the Participants individually and the purpose of the study was explained verbally as well. The raw data was kept in lock and the unanimity of the participants were maintained.

Data Analysis

In this study SPSS version 22 used. For continuous variables mean and standard deviation have been used, and for categorical variables percentage has been used. Data has been presented in the form of charts and tables, and Chi square test was applied to check association.

80 participants were selected by using convenient sampling technique. 6 (7.5%) of the participants were between age 18-28 years, 14 (17.5%) were between 28-38 years, 15 (18.8%) of the participants were between 38-48 years and 45 (56.2%) of the participants’ age was more than 48years (Figure 1).

Figure 1: Age of the participants.

Among the participants 53 (66.2%) were male and 27 (33.8%) were female. 14 (17.5%) of the participants were unmarried while 62 (77.5%) were married, 2 (2.5%) were divorced and 2 (2.5%) were widow (Figure 2).

Figure 2: Marital Status of the participants.

Most of the participants 30 (37.5%) were having higher education, 22 (27.5%) were uneducated, 5 (6.2%) were having primary education, 10 (12.5%) were middle pass, and 13 (16.2%) were matric pass (Figure 3).

Figure 3:  Education Level of the participants.

Among 80 participants 33 (41.2%) were employed and 46 (57.5%) were unemployed and 1 (1.2%) of the participants did not respond to the question (Table 1).

Table 1: Employment Status of the respondents.

Monthly income of the participants between 5000-20000 were 14 (17.5%), 20000-35000 were 15 (18.8%), more than 35000 were 41 (51.2%) and 10 (12.5%) of the participants did not respond to this question (Table 2).

Table 2: Monthly income of the participants

21 (26.2%) of the participants were between 40-60kg, 40 (50%) were between 60-80kg, 14 (17.5%) were between 80-100kg, 2 (2.5 %) were more than 100kgand 3 (3.8%) were not responded (Figure 4).

Figure 4: Weight in KGs.

12 (15%) of the participants were current smokers while 49 (61.2%) were nonsmokers and 19 (23.8%) were Ex-smokers (Figure 5).

Figure 5: Smoking status of the participants.

28 (35%) indicated that they used to exercise sometimes/once a week, 16 (20%)were used to exercise for 30 mints every day and 36 (45%) never exercise. 54 (67.5%) reported eating healthy food sometimes/ once a week, 18 (22.5%) every day and 8 (10%) never eat healthy food.49 (61.25%) of the participants reported to have stressful lifestyle, 15 (18.5%)of participants reported to have very stressful life and 16 (20%) were free from stress (Table 3).

Table 3: Life style/ family history of the study participants.

37 (46.2%) of the respondents were with positive family history and 43 (53.8%) were no family history of CVDs (Table 4).

Table 4: Family history of CVDs.

43 (58.3%) of respondents had high blood pressure, 32 (40%) had diabetes, 29 (36.2%) had high blood cholesterol, and 67 (83.8%) had coronary artery disease. 62 (77.5%) of the respondents who had chronic diseases were taking medication, and 18 (22.5%) reported that they did not take any medicine. Of the study population, 9 (11.2%), 37 (46.2%) and 21 (26.2%) reported that they did not know their recent measures for blood pressure, blood cholesterol and blood glucose, respectively.49 (61.2%) were having normal blood pressure, 26 (32.5%) having normal blood cholesterol level and 41 (51.2%) of the respondents were having normal blood glucose level. 22 (27.5%) , 17 (21.2%) and 18 (22.5%) of the respondents reported that they have high blood pressure, blood cholesterol and blood glucose level, respectively(Table 5).

Table 5: Clinical characteristics of the participants.

Table 6: Blood measures.

Among 80 respondents the mean knowledge score for knowledge about the nine risk factors of CVDs was 5.51 with standard deviation of 2.792 (Figure 6).

Figure 6: Participants score.

30 (37.5%) of the participants were having poor knowledge while 25 (31.2%) had average knowledge, and 25 (31.2%) of the respondents were falling in the category of good knowledge (Table 7).

Table 7: Knowledge Score of the participants.

The commonest risk factors identified by respondents were obesity 56 (70%), hypertension 55 (68.7%), stress 53 (66.2%), diabetes 53 (66.2%), and smoking 49 (61.2%), while least common risk factor was high LDL cholesterol level 39 (48.75%) as highlighted in (Table 8).

Table 8: Respondents knowledge of CVDs risk factors.

In the current study participant’s education level was found to be significantly associated with risk factors of CVDs knowledge with P value ( 0.001), while the others variables were not significantly associated with the CVDs knowledge.

This was the first study conducted in KPK (Peshawar) about the knowledge level of risk factors of cardiovascular diseases. In the current study majority of the participants were having poor knowledge regarding CVDs risk factors. Moreover the study showed that the least common factor was LDL. The results of this study is similar to the study conducted by [8] in Jeddah Saudi Arabia, the study results showed that majority of the respondents were male 41% and the participants knowledge was poor.  Similarly to the findings of the current study, a study conducted in Nigeria by [15], showed that Only 41 (19.9%) of participants were assessed to have good knowledge of heart disease risk factors. Majority, 101 (49.0%) had poor knowledge while 64 (31.2%) had fair knowledge of heart disease risk factors. Most participants did not have a good level of knowledge about risk factors, prevention, treatment and association with diabetes as it relates to heart diseases. In contrast, a study conducted in lahore by [10], the study results shows that among the respondents 67% were having good knowledge and the response were high to “smoking is risk factors of CVD”. 28% of the participants were having good knowledge regarding exercise but the practice were very poor regarding risk factors of CVDs. Similar to the findings of the current study, another study was conducted by [8] the results showed that among men and women, 27.5% and 16.9% respectively were overweight, 39.0% and 53.0% were with low physical activity, 6.9% and 2.5% were current tobacco users. Similarly a study conducted in Malaysia by [9] showed that 88% participants knew that irregular eating pattern can cause CVD. Most of them recognized that smoking and obesity were the risk factors of CVD. 96% were agreed the exercise can prevent CVD. As the findings of this study showed that majority of the participants had poor knowledge regarding risk factors of CVDs in a private sector KPK Peshawar [16-18]. It is recommended that further studies needed to be done in public setup to evaluate the knowledge level in poor and uneducated population. There should be awareness session in hospital settings as well as in the community level to educate the people about CVDs risk factors [19-21].

There are deficiencies in CVDs risk factors knowledge among the study participants, which can cause poor preventative behaviors. Thus the population need wide spread educational programs regarding CVDs risk factors. There should be awareness session in hospital settings as well as in the community level to educate the people about CVDs risk factors.

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