Grant: Project Grant

Cardiac pain disproportionately burdens more women than men. Sex-specific differences in cardiac pain relate to the presentation, pathophysiology, and the clinical outcomes following an acute myocardial infarction (MI)1. Women also have greater symptom burden and a varied pattern and distribution of cardiac and cardiac-related pain symptoms associated with both obstructive and non-obstructive CAD; symptoms differ from those of men and it is difficult for women to interpret these as cardiac-specific2-4. Sex differences in clinical presentations delay appropriate identification of symptoms, appropriate triage, and timely diagnostic testing and management. Over 25% of women will die within a year of their first MI compare to 19% men; and 47% women will die within five years of their first MI compared to 36% men5. Gender differences in women's self-management of cardiac pain practices are affected by broader social, environmental, and community factors. Many women minimize their cardiac pain symptoms, prefer to consult with family and friends, have caring responsibilities and concerns for their family that delay emergency room assessments6. Women with premature MI are often from minority groups and have low socioeconomic status and exposure to sexual abuse during childhood7. Pilote and Norris (co-investigators) reported feminine roles and personality traits were associated with higher rates of recurrent acute coronary syndrome (ACS) and major adverse cardiac events (MACE) compared to masculine characteristics; posited to be explained in part by increased anxiety8. They proposed a gender risk score (GRS), which was associated with a greater severity of CAD at angiography9. We will incorporate condition specific factors such as gender (GRS) and sex (age, race, ethnicity and risk factors) into the HEARTPAIN architecture.