Heart Disease Diagnosed As Stress

The investigation examined the effects of patients' gender and the context of how CHD symptoms are presented (with/without mention of life stressors and anxiety) on primary care physicians' patient evaluations. The researchers found that coronary heart disease (CHD) symptoms presented in the context of a stressful life event were identified as psychogenic in origin when presented by women and organic in origin when presented by men. "The greater prevalence of anxiety disorders in women, along with the greater likelihood that women will discuss stressors with their physicians, and the overlap of CHD and anxiety symptoms, contribute to this shift in interpretation," said lead researcher Gabrielle R. Chiaramonte.

In the studies, 87 internists and 143 family physicians read a vignette of a 47-year-old male or a 56-year-old female (by age at equal risk for CHD) presenting a multitude of CHD symptoms and risk factors. Half the vignettes included sentences indicating the patient had recently experienced a life stressor and that they appeared anxious. Each physician read one version of the vignette and then specified a diagnosis, made treatment recommendations, and indicated the etiology of symptoms.

As the investigators predicted, results showed a gender bias when CHD symptoms were presented in the context of stress, with fewer women receiving CHD diagnoses (15 percent versus 56 percent), cardiologist referrals (30 percent versus 62 percent), and prescriptions of cardiac medication (13 percent versus 47 percent) than men. No evidence of a bias was observed when CHD symptoms were presented without the stress. Results also showed that the presence of stress shifted the interpretation of women's chest pain, shortness of breath and irregular heart rate so that these were thought to have a psychogenic origin. By contrast, men's symptoms were perceived as organic whether or not stressors were present.

Prior to conducting this study, the researchers had tested their hypothesis with 99 first year medical students, 82 third and fourth year medical students, and 122 physician assistant students. They found nearly identical results for all groups.

MEDICA.de; Source: Cardiovascular Research Foundation