Assessment of Knowledge, Awareness, and Practices Regarding Silent Myocardial Infarction Among Elderly Diabetic Patients

ABSTRACT Background: Silent myocardial infarction (SMI) is more prevalent among patients with diabetes mellitus due to altered pain perception and autonomic neuropathy. In elderly diabetic patients, atypical or absent symptoms may delay diagnosis and treatment, increasing morbidity and mortality. Limited awareness of silent presentations and emergency response behaviors remains a significant public health concern. Methods: A cross-sectional study was conducted among 200 elderly diabetic patients attending the Diabetes and Endocrine Center in Sulaymaniyah city between November and December 2025. A structured questionnaire covered demographic profiles, knowledge of SMI, recognition of typical and atypical cardiac symptoms, awareness of risk factors, and health-seeking behavior. Data were analyzed using SPSS version 27; descriptive statistics and chi-square tests were applied, with significance set at p ≤ 0.05. Results: The mean age was 66.6 ± 5.6 years; 61.0% were female and 43.5% were illiterate. Mean diabetes duration was 13.2 ± 8.0 years, and mean HbA1c was 8.0 ± 1.8%, indicating suboptimal glycemic control. Hypertension (67.0%) and hyperlipidemia (65.0%) were the most common comorbidities. While 93.0% had heard of myocardial infarction, only 60.5% recognized that it could occur without chest pain, and 50.0% were aware that diabetic neuropathy may blunt pain perception. Chest pain was the most recognized symptom (65.3%), yet 28.6% could not name any symptom. Among risk factors, hyperlipidemia (46.5%) and hypertension (44.5%) were most frequently identified; 18.0% could not identify any. No significant association was found between sex and SMI awareness (p = 0.159). Significant associations were observed between hypertension and the belief that diabetes raises MI risk (p = 0.043), and between prior MI knowledge and hospital-seeking behavior during chest pain (p = 0.020). Conclusion: Although most participants had general awareness of myocardial infarction, knowledge of silent MI and its atypical symptoms remained inadequate, potentially compromising timely diagnosis and cardiovascular outcomes in this high-risk population. Targeted educational interventions focusing on silent presentations, emergency response, and preventive practices are strongly recommended.