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      Gender-specific Research for Emergency Diagnosis and Management of Ischemic Heart Disease: Proceedings from the 2014 Academic Emergency Medicine Consensus Conference Cardiovascular Research Workgroup

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          Abstract

          Coronary artery disease (CAD) is the most common cause of death for both men and women. However, over the years, emergency physicians, cardiologists, and other health care practitioners have observed varying outcomes in men and women with symptomatic CAD. Women in general are 10 to 15 years older than men when they develop CAD, but suffer worse postinfarction outcomes compared to age-matched men. This article was developed by the cardiovascular workgroup at the 2014 Academic Emergency Medicine ( AEM) consensus conference to identify sex- and gender-specific gaps in the key themes and research questions related to emergency cardiac ischemia care. The workgroup had diverse stakeholder representation from emergency medicine, cardiology, critical care, nursing, emergency medical services, patients, and major policy-makers in government, academia, and patient care. We implemented the nominal group technique to identify and prioritize themes and research questions using electronic mail, monthly conference calls, in-person meetings, and Web-based surveys between June 2013 and May 2014. Through three rounds of nomination and refinement, followed by an in-person meeting on May 13, 2014, we achieved consensus on five priority themes and 30 research questions. The overarching themes were as follows: 1) the full spectrum of sex-specific risk as well as presentation of cardiac ischemia may not be captured by our standard definition of CAD and needs to incorporate other forms of ischemic heart disease (IHD); 2) diagnosis is further challenged by sex/gender differences in presentation and variable sensitivity of cardiac biomarkers, imaging, and risk scores; 3) sex-specific pathophysiology of cardiac ischemia extends beyond conventional obstructive CAD to include other causes such as microvascular dysfunction, takotsubo, and coronary artery dissection, better recognized as IHD; 4) treatment and prognosis are influenced by sex-specific variations in biology, as well as patient-provider communication; and 5) the changing definitions of pathophysiology call for looking beyond conventionally defined cardiovascular outcomes to patient-centered outcomes. These emergency care priorities should guide future clinical and basic science research and extramural funding in an area that greatly influences patient outcomes.

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          Author and article information

          Contributors
          Journal
          9418450
          20159
          Acad Emerg Med
          Acad Emerg Med
          Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
          1069-6563
          1553-2712
          23 January 2019
          20 November 2014
          December 2014
          06 March 2019
          : 21
          : 12
          : 1350-1360
          Affiliations
          Department of Emergency Medicine, Yale University, New Haven, CT
          Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
          The Patient-Centered Outcomes Research Institute, Washington, DC
          College of Nursing, University of Illinois at Chicago, Chicago, IL
          Department of Emergency Medicine, Yale University, New Haven, CT
          Department of Emergency Medicine, Mayo Clinic, Rochester, MN
          Department of Emergency Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
          Section of Cardiology, Department of Medicine, Columbia University, New York, NY
          Department of Emergency Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA; Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI
          National Heart, Lung and Blood Institute (NHLBI), Washington, DC
          Department of Emergency Medicine, University of Maryland, College Park, MD
          Department of Emergency Medicine, University of California, Davis Medical Center, Davis, CA
          Author notes
          Address for correspondence and reprints: Basmah Safdar, MD, MSc; basmah.safdar@ 123456yale.edu .
          Article
          PMC6402042 PMC6402042 6402042 nihpa1007755
          10.1111/acem.12527
          6402042
          25413468
          48548ef9-460a-4da6-9822-d82d2722c430
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