Self-reported diagnosis of heart disease: results from the SHIELD study

Summary Objective: This study evaluated the self‐reported method of diagnosis of heart disease (HD) to elucidate whether diagnosis is occurring at early, presymptomatic stages as recommended by the prevention guidelines. Methods: Respondents to the 2006 survey in the US population‐based Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) reported whether a physician told them that they had HD, including heart attack, angina, heart failure, angioplasty or heart bypass surgery. Self‐report of age at diagnosis, specialty of physician who made the diagnosis and whether the diagnosis was made after having symptoms, during routine screening or while being treated for another health problem were assessed. Year of diagnosis was categorised into 3‐year intervals from 1985 to 2006. Individuals with HD diagnosis with and without type 2 diabetes mellitus (T2DM) were compared using chi‐square tests. Results: Of 1573 respondents reporting a diagnosis of HD, > 87% were white, > 49% were men and 38% had T2DM. Approximately 19% of respondents reported that their HD diagnosis was made during routine screening. A significantly greater percentage of HD respondents with T2DM reported the diagnosis being made based on symptoms (54%) and while being treated for another health problem (22%) compared with respondents without diabetes (48% symptoms and 15% other health problem, p > 0.05). HD was diagnosed primarily by cardiologists (> 60%) and family doctors (> 25%). Conclusion: There remains a missed opportunity to diagnose HD at earlier stages through routine screening or during treatment of other health conditions such as diabetes, as many individuals were not diagnosed until they were symptomatic.