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. 2025 Mar 28;27(4):euaf032.
doi: 10.1093/europace/euaf032.

PULSE survey: Population Survey on Knowledge, Gaps and Perception of Heart Rhythm disorders-an initiative of the Scientific Initiatives Committee of the European Heart Rhythm Association

Melanie A Gunawardene  1   2 , Helmut Pürerfellner  3 , Jose L Merino  4 , Dominik Linz  5   6 , Arian Sultan  1   2 , Daniel Scherr  7 , Jean Claude Deharo  8   9 , Peter Wohlmuth  10 , Johannes Feldhege  10 , Francisco Moscoso Costa  11 , Silvia Ribeiro  12 , Emmanouil Charitakis  13   14 , Axel Verstrael  15 , Matteo Anselmino  16 , Gabor Szeplaki  17 , Stefan Simovic  18   19 , Tomasz Jadczyk  20   21   22   23 , Raquel Adelino  24 , Ioannis Katsoularis  25 , Max Liebregts  26 , Roland Richard Tilz  27   28 , Kyoung-Ryul Julian Chun  29
Affiliations

PULSE survey: Population Survey on Knowledge, Gaps and Perception of Heart Rhythm disorders-an initiative of the Scientific Initiatives Committee of the European Heart Rhythm Association

Melanie A Gunawardene et al. Europace. .

Abstract

Aims: Despite increasing prevalence, the general population lacks knowledge regarding diagnosis, implications, and management of cardiac arrhythmias (CA). This study aims to assess public perception of CA and identify knowledge gaps.

Methods and results: The 36-item PULSE survey was disseminated via social media to the general population and conducted under the auspices of the European Heart Rhythm Association Scientific Initiatives Committee (EHRA SIC) with EHRA patient committee support. Among 3924 participants (2177 healthy, 1747 with previously diagnosed CA; 59% female, 90% European), 81% reported fear of CA. Females were more likely to be 'very' or 'moderately afraid' than males [odds ratio (OR) 1.159 (1.005, 1.337), P = 0.046]. While most recognized complications of CA-heart failure (82%), stroke (80%), and death (75%)-43% were unaware that CA can be asymptomatic. Those with cardiopulmonary resuscitation (CPR) training in the past 5 years were 2.6 times and 4.7 times more confident identifying sudden cardiac death and initiating CPR (P < 0.001). Confidence was lower in retired participants [OR 0.574 (0.499, 0.660), P < 0.001] and Southern Europeans [OR 0.703 (0.600, 0.824), P < 0.001]. Without CPR training, only 15% felt confident initiating CPR. Among CA participants, 28% reported severe to disabling daily symptoms. Males were more often asymptomatic (20% vs. 9%, P < 0.001). Treatment rates were comparable between sex categories (81% vs. 79%, P = 0.413). Interdisciplinary shared decision-making processes were reported by 4%. Notably, 1 in 10 CA cases was self-diagnosed using a wearable device, and 30% of CA participants used smartwatches for self-monitoring.

Conclusion: Significant knowledge gaps regarding CA exist in the general population. Targeted educational initiatives could be a viable tool to enhance public knowledge, confidence in detecting and managing arrhythmias, particularly for women, who experience greater fear and symptom severity despite similar treatment rates.

Keywords: Atrial fibrillation; Awareness; Cardiac arrhythmias; Cardiac resuscitation; Pulse; Sudden cardiac death.

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Conflict of interest statement

Conflict of interest: M.A.G.: none regarding this work; disclosures outside this work: speaker's honoraria/travel grants/consulting honoraria from Abbott, J&J MedTech, Boston Scientific, Medtronic, Farapulse Inc., Emmar, Lumavision, Biotronik, Bristol Myers Squibb, and Zoll. M.A.: none regarding this work; disclosures outside this work: consultant for Johnson & Johnson and Boston Scientific, clinical proctor for Medtronic, educational grants from Abbott. G.S.: none regarding this work; disclosures outside this work: speaker's honoraria/travel grants/consulting honoraria from Abbott, Bayer, Biosense Webster, Boston Scientific, and Lumavision. All remaining authors have declared no conflicts of interest regarding this work.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Number of participants from countries worldwide (A) and Europe (B).
Figure 2
Figure 2
(A) Definition of CA by the participants of the PULSE survey (multiple answers were acceptable). (B) Knowledge on secondary conditions caused by CAs by the participants of the PULSE survey (multiple answers were acceptable).
Figure 3
Figure 3
Mosaic plot: confidence of taking own and someone else's pulse. For n = 3316 participants that answered both questions. This figure shows the proportion of answers for the level of the participants’ confidence to take their own pulse (x-axis) or someone else’s pulse (y-axis).
Figure 4
Figure 4
The role of symptoms and fear among sex category and treatment status. (A) Symptomatic participants by sex category and treatment status. (B) Moderately or very afraid participants by sex category and treatment status.
See this image and copyright information in PMC

References

    1. Van Gelder IC, Rienstra M, Bunting K V, Casado-Arroyo R, Caso V, Crijns HJGM et al. 2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024;45:3314–414. - PubMed
    1. Gräsner J-T, Seewald S, Bohn A, Fischer M, Messelken M, Jantzen T et al. German resuscitation registry: science and resuscitation research. Anaesthesist 2014;63:470–6. - PubMed
    1. Mathiesen WT, Bjørshol CA, Kvaløy JT, Søreide E. Effects of modifiable prehospital factors on survival after out-of-hospital cardiac arrest in rural versus urban areas. Crit Care 2018;22:99. - PMC - PubMed
    1. Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA et al. 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022;43:3997–4126. - PubMed
    1. Svennberg E, Tjong F, Goette A, Akoum N, Di Biase L, Bordachar P et al. How to use digital devices to detect and manage arrhythmias: an EHRA practical guide. Europace 2022;24:979–1005. - PMC - PubMed

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