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J Cardiopulm Rehabil. 2005 May-Jun;25(3):135-43; quiz 144-5.

Causal attributions for coronary heart disease among female cardiac patients.

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Heart Research Centre, PO Box 2137, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia.



Beliefs about the etiology of coronary heart disease (CHD) can influence patient outcomes following an acute cardiac event. However, past research has focused predominantly on male patients. The present study investigated causal attributions and their associations with actual risk profiles in female cardiac patients.


Female cardiac patients consecutively admitted to hospital after an acute myocardial infarction (AMI) or for coronary artery bypass graft surgery (CAGS) were interviewed in hospital at 2, 4, and 12 months postdischarge.


Among 260 women (mean age = 68.6, SD = 10.4), there was little correspondence between actual and perceived risk factors. Hypertension was least recognized: only 5% of the 180 women who had hypertension acknowledged it as a cause of their CHD. High cholesterol, obesity, and high-fat diet were also underacknowledged, with only 14%, 15%, and 17% of women with these risk factors implicating them in their CHD. A higher percentage, 44%, of smokers and 40% of women with a positive family history acknowledged these risk factors as a cause of their CHD. Women who had no idea about the cause of their CHD constituted 20%. There was little change in causal attributions over the 12-month study period and little apparent impact of cardiac rehabilitation (CR) program attendance on causal beliefs.


Women were more likely to attribute their CHD to smoking or positive family history than to other major modifiable risk factors. The lack of correspondence between actual and perceived risk factors and the lack of impact of CR attendance on causal attributions highlight the need for personalized advice and support regarding risk factor modification.

[Indexed for MEDLINE]

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