Attitudes About Treatment of Coronary Heart Disease Among Women and Men Presenting for Exercise Testing

Abstract

To assess attitudes that could contribute to gender differences in the use of coronary procedures, we surveyed 322 patients presenting for exercise testing at a major teaching hospital. Adjusting for sociodemographic and clinical factors, women and men did not differ significantly in their willingness to seek a second opinion, reduce physical activity, or take drugs to avoid major cardiac surgery, but men were more likely than women to describe themselves as risk takers on a three-item personality measure (adjusted odds ratio 2.5; 95% confidence interval 1.4-4.6). Patients' attitudes about risk should be explored further in studies of gender differences in the use of coronary procedures. METHODSHospitalized and ambulatory patients presenting for exercise testing at Brigham and Women's Hospital during July and August 1993 were eligible for the study. The survey, available in English and Spanish, was completed by subjects before or immediately after exercise testing, prior to discussing test results with their physicians. It assessed willingness to reduce activity or take drugs to avoid major heart surgery, desire for second opinions before major surgery, and three attitudes about risk taking adapted from the Jackson Personality Inventory (Appendix A). 20 Other questions addressed sociodemographic characteristics, overall health, cardiovascular diagnoses and risk factors, past coronary procedures, and cardiac functional status. 21 Data on age, gender, cardiac drug use, and results of exercise testing were obtained from exercise test reports. Subsequent performance of coronary angiography within 90 days was determined from the hospital's computer system. Because referring physicians worked full-time at this hospital or at a staff-model health maintenance organization that directs patients to this hospital for major cardiac procedures, almost all angiography within 90 days would have been performed at this hospital.We compared sociodemographic and clinical variables and attitudes by gender using the 2 test, Fisher's Exact Test, or Student's t test as appropriate. We used logistic regression to assess whether attitudes differ by gender, adjusting for age, race, Hispanic ethnicity, education, income, marital status, living alone, history of myocardial infarction and angina, Specific Activity Scale class, and previous coronary procedures. We also analyzed the use of coronary angiography by attitudes, using logistic regression to adjust for gender, age, exercise test results, and history of myocardial infarction.With a 5% ␣ error, these analyses had 80% power to detect differences of 15% (60% vs 75%) in the proportions of women and men reporting a specific attitude or 10% (5% vs 15%) in the proportions of persons with differing attitudes undergoing angiography; power to detect smaller differences in use of angiography was limited. Two-tailed p values or adjusted odds ratios (ORs) with 95% confidence intervals (CIs) are reported for all results. RESULTSOf the 407 eligible patients, 322 (79.1%) completed the written surv...

Race and Gender Disparities in Rates of Cardiac Revascularization

“…However, familiarity with the procedure rather than race was a much stronger predictor of willingness to undergo treatment. 52 Other studies of cardiac patients 53 and patients with end-stage renal disease have noted that difficulties in trust and communication 54 could be especially problematic for blacks. 50 Patient's perception of risk also seems likely to be important, although previous work has not shown racial differences in perceptions.…”