Patient Risk Interpretation of Symptoms Model (PRISM): How Patients Assess Cardiac Risk

Background While there is a prevailing perception that coronary artery disease (CAD) is a “man’s disease,” little is known about the factors which influence cardiac risk assessment and whether it varies by gender. Objectives 1) Qualitatively capture the complexity of cardiac risk assessment from a p...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2021-08, Vol.36 (8), p.2205-2211
Main Authors: Kreatsoulas, Catherine, Taheri, Cameron, Pattathil, Niveditha, Panchal, Puru, Kakkar, Tanya
Format: Article
Language:English
Subjects:
Aged
Cardiovascular disease
Coronary Angiography
Coronary artery
Coronary artery disease
Coronary Artery Disease - diagnosis
Coronary Artery Disease - epidemiology
Female
Gender
Heart
Heart diseases
Humans
Internal Medicine
Male
Medicine
Medicine & Public Health
Men
Middle Aged
Mixed methods research
Original Research
Patients
Risk Assessment
Risk Factors
Sex Factors
Signs and symptoms
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Summary:Background While there is a prevailing perception that coronary artery disease (CAD) is a “man’s disease,” little is known about the factors which influence cardiac risk assessment and whether it varies by gender. Objectives 1) Qualitatively capture the complexity of cardiac risk assessment from a patient-centered perspective. 2) Explore how risk assessment may vary by gender. 3) Quantitatively validate qualitative findings among a new sample. Design This study was conducted in two parts: (1) semi-structured in-depth interviews were audio-recorded, transcribed verbatim, and analyzed using modified grounded theory; (2) emergent themes were surveyed in a separate sample to validate findings quantitatively. Differences were estimated using 2-tailed t -tests and kappa. Participants Participants who were referred for their first elective coronary angiogram for suspected CAD with at least 1 prior abnormal test were recruited from a tertiary care hospital. Main Measures Patient-centered themes were derived from part one. In part two, patients estimated the probability that their symptoms were heart-related at multiple time points. Results Part 1 included 14 men and 17 women (mean age=63.3±11.8 years). Part 2 included 237 patients, of which 109 (46%) were women (mean age=66.0±11.3 years). Part 1 revealed that patients’ risk assessment evolves in three distinct phases, which were captured using an Ishikawa framework entitled “Patient Risk Interpretation of Symptoms Model” (PRISM). Part 2 validated PRISM findings; while patients were more likely to attribute their symptoms to CAD over time (phase 1 vs. 3: 21% vs. 73%, p
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-021-06770-0