Women with coronary heart disease – making sense of their symptoms and their experiences from interacting with their general practitioners

Abstract

Cardiovascular disease and particularly coronary heart disease (CHD) is the leading cause of death among women and men worldwide. CHD in women, and their symptoms and treatment trajectory are not well understood. Studies indicate gender-related differences in symptom presentation, comorbidity, help-seeking behavior, and the quality of diagnostics and treatment of CHD. Although the incidence rates among men have decreased over the last decades, myocardial infarction among women has been increasing. Studies suggest limited knowledge among patients and doctors about the nature of CHD symptoms in women. Knowledge of patients’ experiences and descriptions of symptoms may have important impact on diagnostic decision-making. This qualitative interview study explored how female patients experienced and understood their CHD symptoms and the treatment provided by their general practitioners (GPs). Nine patients scheduled for coronary artery bypass graft surgery were recruited from the waiting list, and interviewed before surgery. Data were analyzed by drawing on phenomenological method. The women reported various symptoms, including atypical symptoms such as fatigue, back and shoulder pain and dyspnea. The CHD symptoms were sometimes masked, and interpreted as gastro-esophageal reflux, chronic obstructive pulmonic disorder, asthma, nervous problems and muscular pain. While some accepted their doctors’ diagnoses, others perceived their symptoms as due to tiredness, burnout and increasing age. Delayed treatment and misdiagnosis were explained by factors including failing to seek help and misinterpreting symptoms. There were a widespread frustration with doctors’ ignorance of symptom descriptions, diagnostics and treatment approach. Women and their GPs may experience difficulties in recognizing CHD symptoms, resulting in misdiagnosis and inadequate and/or delayed treatment. The quality of the patient–provider communication is vital in preventing these problems. More knowledge and awareness about women’s CHD is needed – both among health providers and in public.