1Master of Clinical Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences. Kermanshah, Iran
2Sports Medicine and Lifestyle Intervention, Imam Reza Hospital, Kermanshah University of Medical Sciences ,Kermanshah.Iran
3Researcher of Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
4Psychiatrist, Kermanshah university of Medical Sciences,Kermanshah,Iran
Introduction: There are significant gender differences in the epidemiology and presentation of cardiovascular diseases (CVDs), physiological aspects of CVDs, response to diagnostic tests or interventions, and prevalence or incidence of the associated risk factors. Considering the independent influence of gender on early dire consequences of such diseases, this study was conducted to investigate gender differences in patients' beliefs about biological, environmental, behavioral, and psychological risk factors in a cardiac rehabilitation program. Materials and Methods: This study has cross sectional design. The sample was composed of 775 patients referred to cardiac rehabilitation unit in Imam Ali Hospital in Kermanshah, Iran. The data were collected using clinical interview and patients’ medical records. The data were analyzed using descriptive statistics such as mean, standard deviation, and chi-square test. To do the statistical analysis, SPSS version 20 was utilized. Results: As the results indicated, there was a significant difference between the beliefs of men and women about risk factors of heart disease (X2= 48.36; P<0.01). Men considered behavioral (55.1%) and psychological (33.7%) risk factors as the main causes of their disease, respectively. On the other hand, women regarded psychological (38.2%) and behavioral factors (26.6%) as the most common causes of cardiac conditions, respectively. Both men and women considered stress as the most important heart disease risk factor (21% and 22.3%, respectively). Also, women were less aware of the risk factors, compared to men. Conclusion: From the patients’ perspective, psychological and behavioral risk factors were the most important causes of cardiovascular diseases (CVDs); moreover, stress was the most influential risk factor for developing cardiac diseases. Thus, learning to control and manage these risk factors can help to prevent the development of CVDs and reduce the occurrence of subsequent cardiac events.
1- Vaccarino V, Badimon L, Corti R, de Wit C, Dorobantu M, Hall A, Koller A, Marzilli M, Pries A, Bugiardini R. Ischaemic heart disease in women: are there sex differences in pathophysiology and risk factors? Cardiovasc Res 2011; 90: 9–17.
2- Wang L, Wang KS. Age Differences in the Association of Severe Psychological Distress and Behavioral Factors with Heart Disease. Hindawi Publishing Corporation. Psychiatry J. 2013;2013: 979623. doi: 10.1155/2013/979623
3- Department of health. Cardiovascular Disease Outcomes Strategy Improving outcomes for people with or at risk of cardiovascular disease. Published to DH website, in electronic PDF format only 2013: 10-29.
4- Bath J, Bohin G, Jones C, Scarle E. Cardiac rehabilitation. 1thed. Wiley-Blackwell Pub 2009;1 : 47-55.
5- Ross RL, Serock MR, Khalil RA. Experimental benefits of sex hormones on vascular function and the outcome of hormone therapy in cardiovascular disease. Curr Cardiol Rev 2008; 4: 309–322.
6-Balfour D, Benowitz N, Fagerstro K, Kunze M, Keil U. Diagnosis and treatment of nicotine dependence with emphasis on nicotine replacement therapy. Eur Heart J 2000; 21: 438–445.
7- National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Reducing risk in heart disease: an expert guide to clinical practice for secondary prevention of coronary heart disease. Melbourne: National Heart Foundation of Australia 2012: 4-18.
8- De A, Podder G, Adhikari A, Haldar A, Banerjee J, De M. Comparative Study of Risk Factors of Cardiac Diseases among Urban and Rural Population. Int J Hum Genet 2013; 13: 15-19.
9- American Heart Association. Obesity and Cardiovascular Disease. Washington, 2013.
10- British Association for Cardiovascular Prevention and Rehabilitation. The BACPR Standards and Core Components for Cardiovascular Disease Prevention and Rehabilitation. (2nd Edition). 2012: 1-22.
11- Péres DS, Magna JM, Viana LA. Arterial hypertension patients: attitudes, beliefs, perceptions, thoughts and practices. Rev Saude Publica 2003; 37: 635-42.
12- Barth J, Volz, A, Schmid J-P, Kohls S, von Kanel R, Znoj H, etal. Gender Differences in Cardiac Rehabilitation Outcomes: Do Women Benefit Equally in Psychological Health? J Womens Health (Larchmt).2009; 18: 1-9.
13- Bhattacharyya MR, Steptoe A. Emotional triggers of acute coronary syndromes: strength of evidence, biological processes, and clinical implications. Prog Cardiovasc Dis 2007;49:353–365.
14- Adel SM, Ramezanei AA, Haydarei A, Javaherizadeh H, Behmanesh V, Amanei V. Gender- related differences of risk factor among patients undergoing coronary artery bypass graft in Ahwaz. Saudi Med J 2007; 28 : 1686-89.
15- Jensen LA, Moser DK. Gender differences in knowledge, attitudes, and beliefs about heart disease. Nurs Clin North Am 2008; 43: 77-104.
16- Askari SH, Mohammadi N, Ghorbani A, Ghafarzadegan R, Babahaji M, Torki Y. Comparison of Depression Level in Patients Prior to and After Implantable Cardioverter-Defibrillator. IDOSI Publications. Advances in Biological Research 2013; 7: 175-179.
17- Glader EL, Stegmayer B, Norrving B. Sex differences in management and outcome after stroke: a Swedish national perspective. Stroke 2003; 34: 1970-5.
18- Sharma K, Gulati M. Coronary Artery Disease in Women: A 2013 Update. Published by Elsevier Ltd. Global Heart 2013: 1-8.
19- Astin F, Jones K. Heart disease attributions of patients prior to elective percutaneous transluminal coronary angioplasty. J Cardiovasc Nurs. 2004; 19: 41-7.
20- Perkins-Porras L, Whitehead DL, and Steptoe A. Patients' beliefs about the causes of heart disease: relationships with risk factors, sex and socio-economic status, Eur J Cardiovasc Prev Rehabil. 2006; 13: 724-30.
21- Day RC, Freedland KE, Carney RM. Effects of anxiety and depression on heart disease attributions. Int J Behav Med 2005; 12: 24-29.
22- Furze G, Lewin RJ, Murberg T, Bull P, Thompson DR. Does it matter what patients think? The relationship between changes in patients' beliefs about angina and their psychological and functional status. J Psychosom Res. 2005; 59 : 323-9.
23- Murphy B, Worcester M, Higgins R, Le Grande M, Larritt P, Goble A. Causal attributions for coronary heart disease among female cardiac patients. J Cardiopulm Rehabil. 2005; 25: 135-43; 144-5.
24- Martje HL, van dW, Jaarsma T, Moser DK, Veeger N, van Gilst WH, etal. Compliance in heart failure patients: the importance of knowledge and beliefs. Eur Heart J. 2006; 27: 434–440.
25- McCabe PJ, Barnason SA, Houfek J. Illness beliefs in patients with recurrent symptomatic atrial fibrillation. Pacing Clin Electrophysiol 2011; 34: 810-20.
26- Darr, A, Astin, K. Atkin, K. Causal attributions, lifestyle change and coronary heart disease: illness beliefs of patients of South Asian and European origin living in the UK. Heart & Lung -The Journal of Acute & Critical Care 2008; 37: 91-104.
27- Tirodkar MA, Baker DW, Khurana N, Makoul G, Paracha MW, Kandula NR. Explanatory models of coronary heart disease among South Asian immigrants. Patient Educ Couns 2010: 1-7.
28- Hirani SP, Newman SP. Patients’ beliefs about their cardiovascular disease. Heart 2005; 91: 1235–1239.
29- Emslie, C. Women, men and coronary heart disease: a review of the qualitative literature. J Adv Nurs 2005; 51: 382-395.