Women's heart ills are often dismissed
Study says doctors blame stress more
MINNEAPOLIS - Family physicians and internists, when confronted with patients who are stressed out and showing signs of heart problems, are more likely to chalk up the symptoms to anxiety if the sufferer is female, according to a study.
When the patients didn't complain of a specific and recent source of stress in their lives, there was no difference in the way men and women were diagnosed for heart disease or referred to a cardiologist.
The findings, presented at the Transcatheter Cardiovascular Therapeutics meeting in Washington yesterday, may help explain why women often don't get prompt treatment for heart disease, which is their leading cause of death, the researchers said.
Doctors in the study read vignettes about a 47-year-old man or a 56-year-old woman, whose ages would have given them a similar risk of heart disease.
When the story said the patient appeared anxious and reported a recent cause of stress, doctors interpreted chest pain, shortness of breath, and irregular heart rates as psychological symptoms rather than heart disease more than twice as often in the woman. In reality, stress is a risk factor that can signal an elevated risk of heart disease in anyone, the researchers said.
"Given the overlap of coronary heart disease and anxiety symptoms, and given the higher prevalence of anxiety symptoms or disorders in women, physicians need to be aware of gender differences," said researcher Gabrielle Chiaramonte, a postdoctoral associate at Weill Medical College of Cornell University in New York. "They need to be especially careful to rule out coronary heart disease before considering an anxiety diagnosis," she said.
The physician's gender did not affect results. An earlier study yielded similar findings among medical students and physician assistant students, showing bias is widespread, researchers said. Given that women are more likely to discuss stress with their doctors, and don't always have conventional symptoms of heart disease such as chest pain, physicians need to be aware of gender bias, they said.
"We know that there is a delay in diagnosing coronary heart disease in women, and this is an important step forward in understanding why," said Alexandra Lansky, an associate professor at Columbia University College of Physicians and Surgeons and director of the Women's Health Initiative at the Cardiovascular Research Foundation in New York. 