Canadian Journal of Cardiology



      Coronary artery disease (CAD) a leading cause of mortality among women and despite this, there is a perception that “CAD is a man's disease”. Little is known about the perceptions that influence patients and how it affects the process to seek medical care. The study objectives include 1) to understand from a gender-centered patient perspective the underlying process that urge women and men to seek medical attention when experiencing chest-pain and 2) to determine the association of factors which influence a patient’s decision to seek medical care.


      Using a mixed Methods approach, the study was conducted in two parts: first, angina symptoms and perceptions influencing the decision to seek medical care were qualitatively explored using in-depth semi-structured interviews and analyzed using modified grounded theory approach. A new cohort of patients was enrolled into the second phase of study, which sought to quantify the reasons why patients decided to seek care according to gender. The entry criteria for both studies were the same: patients with suspected CAD and at least one prior abnormal test, referred for their first coronary angiogram. Logistic regression was used to estimate the association of gender with factors that influence seeking medical care, adjusted for age.


      The qualitative analysis of 31 men and women revealed that symptoms alone did not prompt medical care. We developed the term, “symptomatic tipping point” to capture the transitional period between experiencing the symptom and seeking medical attention. We identified 6 stages before patients seek medical attention and the stages were similar between men and women varying only in duration between and within the stages, as women would wait for a more severe confirmatory event to occur before they would qualify their symptoms as “possibly cardiac”. In our quantitative study of 237 patients we found that men would seek medical attention when they perceived that their symptoms were “severe” (OR=2.1 95%CI 1.2-3.7) and if the symptoms occurred “more frequently” (OR=1.9, 95%CI 1.1-3.3) compared to women.


      We captured the process in which patients seek medical attention, as the symptomatic tipping point. Women and men went through a similar series of stages, however women would often delay seeking care for more severe or frequent symptoms to occur. The reasons for this are unclear. This has important public health implications to improve timely cardiac care among women.