Patient reactions to the diagnosis of asymptomatic coronary artery disease. Implications for the primary physician and consultant cardiologist

The diagnosis of asymptomatic coronary artery disease is increasing as a result of the widespread use of noninvasive screening techniques. Because its natural history is unknown and as there is continuing controversy over proper treatment, both primary physicians and consultant cardiologists are often unsure how to approach patients with this disorder. This uncertainty on the part of physicians, combined with the paradox of having serious heart disease without symptoms, often leads to psychologic stress in patients and their families. In a pilot study to evaluate the psychologic impact of the diagnosis of asymptomatic coronary artery disease, we elicited the reactions from 15 patients with either totally or partially asymptomatic coronary artery disease. In general, patients and spouses were surprised and concerned by the diagnosis, but most felt their physicians had been supportive in explaining the problem to them. Because patients trusted their physicians, they often changed their lifestyles markedly in regard to exercise and diet; some even underwent coronary surgery when it was recommended. Public awareness of the disorder was generally felt to be almost nonexistent. This pilot study provides insight into a subgroup of patients with potentially serious psychologic problems and the implications of these problems for their physicians.