1. Astin, Felicity RN, BSc (Hons), MSc
  2. Jones, Kenneth BA, MA, PhD


One hundred forty consecutive subjects attending a clinic prior to undergoing elective percutaneous transluminal coronary angioplasty were asked about what they believed had caused their coronary heart disease (CHD). The aim was to determine gender differences in responses and compare patients' perceived causal attributions for CHD with their own coronary risk factor profile documented by their attending physician. Female subjects most commonly cited stress as the cause of their CHD, followed by family history, cholesterol, and cigarette smoking. Males showed a different pattern of attribution, with poor diet being the most frequently cited factor, followed by cigarette smoking, stress, and family history. A significantly greater proportion of males than females attributed their illness to behavioral causes rather than to biological causes. A positive history for the coronary risk factors cholesterol (84%), family history (43%), and hypertension (55%), as documented by attending physician, was discordant with causal attributions expressed by patients which were 17%, 31%, and 4% respectively. These findings demonstrate the need to improve communication and find a common "platform" of understanding between patient and practitioner when discussing coronary risk factors in order to establish a collaborative action plan for successful and long-term lifestyle change.


When an individual is diagnosed with a serious illness, his/her concept of self may be irrevocably altered. A process of "coming to terms" with the new situation begins. Part of this evolution involves finding a believable cause for the illness. 1,2 Beliefs about causes (causal attributions) are important because they affect participation in rehabilitation, recovery from illness, and influence coping strategies. 3-9