Gender Differences in Coronary Artery Disease, Congestive Heart Failure, and Cardiovascular Resuscitation

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 are 10-15 years older than men when they develop CAD but suffer worse post infarction outcomes compared to age-matched men. Recent data indicate that the full spectrum of gender-specific risk as well as presentation of cardiac ischemia may not be captured by our standard definition of CAD. Diagnosis is further challenged by sex/gender differences in presentation, and variable sensitivity of cardiac biomarkers, imaging and risk scores. Sex-specific pathophysiology of cardiac ischemia extends beyond conventional obstructive coronary artery disease to include other causes such as microvascular dysfunction, takotsubo, and coronary artery dissection. Treatment and prognosis is influenced by gender-specific variations in biology, as well as patient-provider communication. The changing definitions of pathophysiology call for a fresh look at conventionally defined cardiovascular outcomes. This survey was developed as part of the cardiovascular workgroup at 2014 Academic Emergency Medicine consensus conference and the five key themes below will be discussed on the day of the consensus conference. We would like your feedback on these questions and any other issues you think are relevant to our discussion for future research.