A systematic review of the medical experiences of women and men living with coronary heart disease.

A total of 266 studies were screened, of which 43 were included (Figure 1). 2). 11 studies were conducted in the United States^{twenty one,twenty two,twenty three,twenty four,twenty five,26,27,28,29,30,31}nine were British^{32,33,34,35,36,37,38,39,40}seven came from Canada^{41,42,43,44,45,46,47}five came from Sweden^{48,49,50,51,52}three came from Australia^53,54,55two were Finnish^56,57and one study each from Austria, Brazil, Denmark, Italy, New Zealand, and Spain (Supplementary Table) 1)^{58,59,60,61,62,63}.

A total of 1522 people (62% female, CHD patients or CHD healthcare professionals) were included in the included studies. 20 studies focused on women's experiences with CHD^{twenty two,twenty four,28,29,34,36,37,38,39,40,41,47,48,49,50,53,55,63}three studies focused on the experiences of men with CHD.^46,60,62Nineteen studies included a combination of women and men.^{twenty one,twenty three,twenty five,26,27,32,33,35,42,43,44,52,54,56,57,59,61}two studies did not report gender breakdown.^31,51. No studies reported nonbinary, gender diverse, or transgender people. Three studies included only healthcare workers^31,51,58one study included CHD patients and healthcare professionals.³⁰One study included CHD patients and caregivers⁴⁵.

A variety of qualitative data collection methods were utilized, including interviews, interviews following the presentation of vignettes, content analysis, and focus groups. Few studies have provided summary statistics on socio-economic status (n= 6) and education (n= 14), respectively. Heterogeneity and limited data hampered the ability to combine data for meta-analysis.

quality evaluation

Of the included studies, 8 (18.6%) were rated as high quality, 29 (67.4%) as medium quality, and 6 (13.9%) as low quality (Supplementary Table) 1). Six low-quality studies differed from high-quality studies because they lacked a consistent explanation of the theoretical underpinnings of the study design and did not adequately consider the participant-researcher relationship. Ta. The thematic results of this study were sporadically interspersed with low-quality studies, which minimized the risk of bias.

Research theme

Four main themes were identified. Assumptions about CHD (interpreting signs and symptoms, seeking help). Roles assigned to gender. Interaction with medical care. and return to “normal” life.

Assumptions about CHD: Interpretation of signs and symptoms

Studies have reported that both women and men have assumptions about CHD, particularly regarding perceptions of who is a “typical” heart attack candidate.

The frequently cited belief that CHD is a “men's disease” has led many women to question their own signs and symptoms. Women reported being highly uncertain about their symptoms (n= 12 studies), we often attribute any signs or symptoms to non-cardiac causes, such as aging, arthritis, or fatigue, and often try to convince ourselves that the symptoms will go away with rest.^{twenty two,twenty three,twenty four,28,30,35,36,37,41,48,49,60}. This often did not match the symptoms women thought of as a “classic heart attack.” This is because there is no acute, heart-wrenching pain that is often described, but instead a gradual onset of symptoms such as nausea and shortness of breath is often reported. Level of confusion and delay when seeking help^{28,31,32,53,58}. In contrast, men had clearer descriptions of their symptoms, which were more commonly recognized as heart symptoms requiring medical attention.^{twenty three,60,63} Riegel et al.^{twenty three} suggested that this is because men are more confident in their decision-making, receive greater social support, and symptoms are more in line with public perceptions of CHD as a men's disease. .

Similarly, identifying the signs and symptoms of CHD can also be difficult in a typical “heart attack” patient (often described in research as being male, overweight, a smoker, and someone who did little exercise). It was more difficult because Therefore, participants, especially women who thought they were not at risk if they did not adopt a “man's way of life,” were confused about what was going on when their own self-image was different. Ta.^{twenty three,38,39}.

Assumptions about CHD: Seeking help.

Women preferred to “wait and see” and often delayed seeking medical help. Research shows that delays are often due to confusion over signs and symptoms that don't match previous perceptions of CHD, leading women to self-medicate before “disturbing” others or for symptoms to disappear. It is said that he took a break to check whether the situation was true or not.^{twenty three,27,30,33,37,58}. Research shows that women are more likely to seek medical help until they are incapacitated because they don't want others to see them as a nuisance, ignorant, or hypochondriac.

Women also described important activities and responsibilities that prevented or delayed seeing a doctor.^{twenty two,49,52}. Concern for family members often leads to neglect of symptoms because they are unable to delegate responsibilities such as housework or caring for other family members to others, and treatment of symptoms does not “fit” into their lives. did.^{twenty two}.

Seeking advice from friends and family before seeking medical care is commonly reported by both women and men, with many seeking medical care only at the insistence of friends and family. A next of kin (usually the daughter) was instrumental in arranging medical treatment³⁷. Wives are commonly the trigger for men to seek help, advocating for them to address symptoms and seek care.^37,40,52 And this was reported by Brink et al.⁵² This is one of the reasons why men seek medical care earlier than women. However, it has not been reported that the woman's husband was the reason for her seeking help.

Logistical concerns, such as lack of transportation, understaffing of health centers, and waiting times, were also often the reasons why women delayed seeking specialized health care, especially in rural and rural areas.^{twenty two,29,54}.

Rosenfeld et al.²⁹ Women reported that they preferred to see their general practitioner rather than attend emergency services because they often felt that their symptoms were not severe enough to waste emergency services' time.

gender roles

As previously mentioned, women commonly speak of a sense of responsibility towards family and home, placing obligations to others above their own health needs. For women, the disruption to the normalcy of daily life reportedly caused anxiety, and many tried to hide their emotions to protect their families from worry.^{twenty two,49}. Research shows that although women hope to be discharged from the hospital after treatment, many report anxiety about the future and worry that their illness will affect their role as caregivers for their families. There is^40,47,55.

This sense of responsibility towards family and home was less common among men. Research has shown that men are more concerned about their social status and how their recovery period will affect how others see them, or how their family's “responsibility” will change if they are forced to cut back on work. It has been observed that there are concerns about how this fits in with their role as breadwinners. their workload^44,45.

Cewers et al.⁵¹ Health professionals tended to have specific gender role perceptions, which they reported influenced their advice regarding home recovery. Men were seen as 'workers' and were more likely to play sports than women, whereas women were seen as carers and housekeepers and were more likely to participate in yoga or walking for recovery.

Interaction with medicine

Four studies focused specifically on patients' experiences with healthcare professionals, and gender differences were evident in these interactions^{twenty two,30,56}.

Women said they were “not listened to” by medical professionals and reported that they were often fired because their explanations of symptoms were not specific.^{twenty two,40,55}. Women also expressed frustration with the lack of information provided regarding initial diagnosis and discharge.^40,55. This finding was related to the need to organize their household duties and “future plans”.

In contrast, medical professionals noted that women are often seen as emotional and “suffering” and are unable to articulate their symptoms, making it difficult to reproduce their pain manifestations.^51,58. These studies conclude that diagnosis is more difficult because women are often older, have more complex symptoms, and are at later stages of the disease because they are slower to seek help.

Women tend to have stronger emotional reactions to diagnosis than men, with most women reporting feelings of sadness and resignation.^26,40,59. Cheka et al.⁵⁹ Women are more concerned about the future and how their illness will affect their role in the family, whereas men tend to be more relaxed and even optimistic about being 'cured'. I explained that there is. However, this was in contrast to Evangelista et al.²⁶ They reported that women tended to use more optimistic coping strategies than men, while men tended to use more emotion-focused and fatalistic coping strategies.

In one study focusing on men's psychological reactions and experiences after a cardiac event, participants reported difficulty adjusting to a new post-mortem identity and accepting a new 'role'.⁴⁶.

return to new normal

A desire to return to familiar life was reported by both women and men^40,44,47,55. However, women are more likely than men to worry about the practical support they will need upon returning home (shopping, cleaning, etc.), and women are more diligent in planning their recovery period so that they can return to “normal” life as quickly as possible. It is reported that it is now able to stand. as much as possible⁴⁷. Men reported being afraid to be discharged home because they do not know what life will be like in terms of employability, sexual virility, and others' perceptions of them.^44,45.

Upon returning home, women often talked about losing control over their home situation and seemed to equate this loss of role function with a decline in their worth as a person.^34,45,47. Women reported being willing to talk about their illness and listen to other patients, while men were less likely to want to share their thoughts and feelings and were more likely to self-isolate.^44,52.