Decreased health care use among patients with silent myocardial ischemia: support for a generalized rather than cardiac-specific silence

Objective: The absence of angina among patients with silent myocardial isch emia (SMI) may be a cardiac phenomenon or may reflect a generalized lack of bodily awareness and symptom reporting. We tested the hypothesis that the silence is generalized, and, therefore, that patients with SMI would make f ewer health care visits for noncardiac/chest-pain problems than patients wi th symptomatic ischemia. Methods: We counted all out-patient visits to our medical system for the prior 18 months for 95 patients who demonstrated isc hemia during treadmill exercise testing and subsequent nuclear scanning: 62 of the patients had SMI during exercise, and 33 of the patients had sympto matic ischemia. Results: Patients with SMI made were significantly less lik ely to have sought emergency care or primary care and had significantly few er primary care visits than patients with symptomatic ischemia. Group diffe rences remained after controlling for demographics and health status variab les. The two groups did not differ on utilization of specialty care. Conclu sion: The reduced use of emergency and primary care among patients with SMI suggests that they have a generalized rather than cardiac-specific reducti on in somatic awareness and/or symptom reporting. (C) 2000 Elsevier Science Inc. All rights reserved.