Heart disease more often misdiagnosed as stress in women, than men

Gender bias in medicine is alive and well, according to the investigative study - Gender Bias in the Diagnosis, Treatment, and Interpretation of CHD Symptoms: Two Experimental Studies with Internists and Family Physicians." The study, led by Gabrielle R. Chiaramonte, Ph.D., postdoctoral associate at the Weill Medical College of Cornell University and Clinical Fellow at New York-Presbyterian Hospital, looked specifically at the effects of patients' gender on how coronary heart disease symptoms are evaluated by primary care physicians.

The researchers found that stressful events in the lives of women were "pyschogenic" in origin, but "organic" in origin when the same symptoms presented in men. Specifically, in the study, 87 internists and 143 family physicians were asked to interpret a "vignette" of a 47-year-old male or a 56-year-old female presenting a variety of coronary heart disease (CHD) symptoms and risk factors. After reviewing the vignettes, the doctors specified a diagnosis and made treatment recommendations. As the investigators suspected, the results showed a clear gender bias when CHD symptoms were presented in the context of stress, with fewer women -15% - receiving CHD diagnoses, compared to 56% of the men. In addition, women were referred to cardiologists just 30% of the time, compared to 62% for men, and the doctors prescribed cardiac medication to just 13% of the women, versus 47% of men. The bottom line? Primary care doctors are more likely to attribute shortness of breath, chest pain and other symptoms of heart disease to stress in women than when they see the same symptoms in men.

"We know that there is a delay in diagnosing CHD in women and this is an important step forward in understanding why," said Alexandra J. Lansky, M.D., director of the Women's Health Initiative at the Cardiovascular Research Foundation (CRF). The CRF sponsored the 20th annual Transcatheter Cardiovascular Therapeutics  scientific symposium, at which the research was presented last fall. And warns Dr. Chiaramonte, "Given the overlap of CHD and anxiety symptoms (e.g., chest tightness common in both) and given the higher prevalence of anxiety symptoms or disorders in women, physicians need to be aware of gender differences in symptom presentation and they need to be especially careful to rule out CHD before considering an anxiety diagnosis. In the case of women, anxiety appears to have a pervasive influence on medical judgments regardless of the gender of the health care provider making the evaluations. Our results suggest the need for the development of educational initiatives aimed at improving health care providers' understanding of gender differences in symptom presentation."