Women’s Ischemic Syndrome Evaluation

The WISE workshop was convened to review results from the Women’s Ischemic Syndrome Evaluation (WISE) study and other studies of ischemic heart disease to examine the nature and scope of gender differences in both chronic and acute cardiac ischemia, in terms of clinical manifestations, detection, and treatment. This section addresses research needs in the diagnosis and treatment of acute coronary syndromes in women and in the effective implementation of these findings into the community. There is a substantial body of scientific literature about the presentation of acute cardiac ischemia (ACI) in women, including acute myocardial infarction (AMI) and unstable angina pectoris, which can lead to AMI. However, the diagnosis and treatment of ACI in women in the emergency department (ED) is not optimal, resulting in missed diagnoses and treatments and leading to excess mortality.1 Women present at older ages, in different social support environments, with more comorbidity, and with some differences in symptoms compared with men, and women are more likely to present with unstable angina pectoris than with AMI.2–8 Also, gender-specific clinical practices are not well understood or implemented.9–18 Particularly needed for improving health outcomes in women with ACI is a better understanding of how care for women with (and without) ACI can be effectively delivered in the wide range of care settings in this country. Thus, there is a clear need to supplement prior, excellent, disease-targeted “efficacy research” with “effectiveness research” that targets the development and testing of approaches that are broadly applicable to usual clinical practice settings.19,20 This next phase of research must avoid the incomplete inclusion of all patients with …