Table Of ContentC D W
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ONTEMPORARY ARDIOLOGY
CHRISTOPHER P. CANNON, MD
SERIES EDITOR
Coronary Disease in Women: Evidence-Based Aging, Heart Disease, and Its Management,
Diagnosis and Treatment, edited by Leslee Facts and Controversies, edited by Niloo M.
J. Shaw, PhD and Rita F. Redberg, MD,FACC, Edwards,MD, Mathew S. Maurer, MD, and
2004 Rachel B. Wellner, MPH, 2003
The Columbia University New York Presbyterian Peripheral Arterial Disease: Diagnosis and
Manual of Cardiac Transplantation, edited Treatment,edited by Jay D. Coffman, MD and
byNiloo M. Edwards, MD, Jonathan M, Chen, Robert T. Eberhardt, MD, 2003
MD, and Pamela A. Mazzeo, 2004 Primary Angioplasty in Acute Myocardial
Heart Disease and Erectile Dysfunction, Infarction,edited by James E. Tcheng, MD,
edited by Robert A. Kloner, MD,PhD, 2004 2002
Complementary and Alternative Medicine in Cardiogenic Shock: Diagnosis and
Cardiovascular Disease, editedbyRichard Treatment,edited by David Hasdai, MD, Peter
A. Stein, MD and Mehmet C. Oz, MD, 2004 B. Berger, MD, Alexander Battler, MD, and
Minimally Invasive Cardiac Surgery, Second David R. Holmes, Jr., MD, 2002
Edition,edited by Daniel J. Goldstein and Management of Cardiac Arrhythmias, edited
Mehmet C. Oz, MD,MD, 2004 by Leonard I. Ganz, MD, 2002
Nuclear Cardiology, The Basics: How to Set Up Diabetes and Cardiovascular Disease,
and Maintain a Laboratory, edited by Frans edited by Michael T. Johnstone and Aristidis
J. Th. Wackers, MD,PhD, Wendy Bruni, BS, Veves,MD,DSC, 2001
CNMT, and Barry L. Zaret, MD, 2004 Blood Pressure Monitoring in Cardiovascular
Cardiovascular Health Care Economics, Medicine and Therapeutics, edited by
edited by William S. Weintraub, MD, 2003 William B. White, MD, 2001
Platelet Glycoprotein IIb/IIIa Inhibitors in Vascular Disease and Injury: Preclinical
Cardiovascular Disease, Second Research,edited by Daniel I. Simon, MD,
Edition,edited by A. Michael Lincoff, MD, and Campbell Rogers, MD 2001
2003 Preventive Cardiology: Strategies for the
Heart Failure:A Clinician's Guide to Prevention and Treatment of Coronary
Ambulatory Diagnosis and Treatment, Artery Disease, edited by JoAnne Micale
edited by Mariell L. Jessup, MD,FACC,FAHA, Foody,MD, 2001
and Evan Loh, MD,FACC,FAHA, 2003 Nitric Oxide and the Cardiovascular System,
Cardiac Repolarization: Bridging Basic and edited by Joseph Loscalzo, MD,PhD, and
Clinical Science, edited by Ihor Gussak, MD, Joseph A. Vita, MD, 2000
PhD, Charles Antzelevitch, PhD, Stephen Annotated Atlas of Electrocardiography:
C. Hammill, MD,coedited by Win-Kuong A Guide to Confident Interpretation,
Shen,MD, and Preben Bjerregaard, MD,DMSc, byThomas M. Blake, MD, 1999
2003 Platelet Glycoprotein IIb/IIIa Inhibitors in
Essentials of Bedside Cardiology: With a Cardiovascular Disease,edited by A. Michael
Complete Course in Heart Sounds and Lincoff,MD, and Eric J. Topol, MD, 1999
Murmurs on CD, Second Edition, Minimally Invasive Cardiac Surgery,edited by
byJules Constant, MD,FACC, 2003 Mehmet C. Oz, MD, and Daniel J. Goldstein,
Management of Acute Coronary Syndromes, MD, 1999
Second Edition, edited by Christopher P. Management of Acute Coronary Syndromes,
Cannon,MD, 2003 edited by Christopher P. Cannon, MD, 1999
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IN OMEN
Evidence-Based Diagnosis and Treatment
Edited by
L J. S ,
ESLEE HAW PhD
Outcomes Research, American Cardiovascular Research Institute,
Atlanta, GA
R F. R , ,
ITA EDBERG MD FACC
Division of Cardiology, University of California School
of Medicine, San Francisco, CA
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Library of Congress Cataloging-in-Publication Data
Coronary disease in women : evidence-based diagnosis and treatment / edited by Leslee J. Shaw and Rita F. Redberg.
p. ; cm. -- (Contemporary cardiology)
Includes bibliographical references and index.
1. Heart diseases in women. 2. Coronary heart disease. 3. Evidence-based medicine. I. Shaw, Leslee J., 1957–
II. Redberg, Rita F. (Rita Fran), 1956– III. Contemporary cardiology (Totowa, N.J. : unnumbered)
[DNLM: 1. Coronary Disease--diagnosis. 2. Coronary Disease--therapy. 3. Evidence-Based Medicine. 4. Sex
Factors. 5. Women's Health. WG 300 C82173 2004]
RC685.C6C635 2004
616.1'2'0082--dc21
2003049990
P
REFACE
Coronary Disease in Women: Evidence-Based Diagnosis and Treatment provides a
clinical management approach to the care of women with known or suspected coronary
artery disease. Whereas previous books on the subject have focused on gender-based
differences in the epidemiology of coronary disease as well as in gender bias in treatment,
this text focuses on the daily clinical management of women using an evidence-based
approach.
Because women’s health is also a critical issue to health care administrators, an increas-
ingly important decision maker in health care, additional chapters address managing
women’s health issues in our current era of managed care and organizing a women’s health
center. Topical issues on the effectiveness of using a gynecologist to diagnose or manage
coronary disease, as well as the cost effectiveness of diagnosis and treatment are also
included.
In the current health care era, there is an increased use of guidelines or pathways of care
that are developed within managed care organizations to deal with coronary artery dis-
ease.Coronary Disease in Women includes special management issues with women in
developing clinical pathways, including those of primary and secondary prevention of
coronary heart disease. Primary care physicians, including cardiologists, family practi-
tioners, and general internists should find this text both informative and timely.
ACKNOWLEDGMENT
We would like to thank Lesley Wood, MA, for her editorial assistance with this book.
Leslee J. Shaw, PhD
Rita F. Redberg, MD,FACC
v
C
ONTENTS
Preface............................................................................................................................v
Contributors...................................................................................................................xi
P I. I
ART NTRODUCTION
1 The Institute of Medicine Report, Women’s Cardiovascular
Health, and Evidence-Based Medicine........................................3
Nanette K. Wenger
2 Evidence-Based Medicine in the Assessment of Women
at Risk for Cardiovascular Disease..............................................9
Leslee J. Shaw
P II. S D C D W
ART CREENING AND IAGNOSIS OF ORONARY ISEASE IN OMEN
A. Cardiovascular Epidemiology in Women
3 Population-Based Sex Differences in Disease Incidence
and Prevalence............................................................................19
Brandi J. Witt and Véronique L. Roger
4 Risk Detection and Primary Prevention in Women.......................29
Lori Mosca and Leslee J. Shaw
5 Early Detection of Coronary Artery Disease in Women:
Role of Coronary Artery Calcium Scanning With EBT.............47
John A. Rumberger
6 Heart Failure in Women: Epidemiology, Gender Differences
in Pathophysiology, and Implications for Therapy...................65
Daniel P. Morin, Marvin A. Konstam,
Michael E. Mendelsohn, and James E. Udelson
7 Diastolic Dysfunction in Women...................................................93
Mary Norine Walsh and Mariell Jessup
8 Functional Capacity and Activities of Daily Living
in Women..................................................................................103
Claire E. Pothier Snader and Michael S. Lauer
9 Special Considerations for Minority Women ..............................119
Jennifer H. Mieres and Elizabeth Ofili
B. Varying Symptom Presentation in Women
10 Clinical Risk Assessment in Women: Chest Discomfort.
Report from the WISE Study.....................................................129
B. Delia Johnson, Sheryl F. Kelsey, and C. Noel Bairey Merz
11 Quality-of-Life Issues for Women With Coronary Disease........143
John Spertus and Darcy Green-Conaway
vii
viii Contents
C. Choosing the Best Diagnostic Test for Women
12 Should All Women With Suspected Coronary Disease
Undergo Stress Cardiac Imaging?............................................161
Anthony P. Morise
13 State-of-the-Art Diagnostic Testing in Women:
A Research Update...................................................................173
Leslee J. Shaw, B. Delia Johnson, Sharon Mulvagh,
Jennifer H. Mieres, Rita F. Redberg, and
C. Noel Bairey Merz
P III. M C D W
ART ANAGEMENT OF ORONARY ISEASE IN OMEN
A. Evaluation of Stable Chest Pain Syndromes in Women
14 Treatment Strategies for Women With Stable Angina................197
Paul R. Casperson, Leslee J. Shaw, and Robert A. O’Rourke
15 Improving the Diagnosis and Management of Women
With Coronary Disease in Primary Care Settings ...................215
Kimberly J. Rask
B. Evaluation of Acute Ischemic Syndromes in Women
16 Evaluation of Acute Chest Pain in Women..................................227
Andra L. Blomkalns, W. Brian Gibler,
and L. Kristin Newby
17 Acute Ischemic Syndromes: Differences in Presentation
and Treatment in Women .........................................................243
Jane A. Leopold and Alice K. Jacobs
C. Variations in Therapeutic Effectiveness in Women
18 Effectiveness of Coronary Revascularization:
Gender and Racial Differences................................................269
Christi Deaton, Cherie L. Kunik, and Eric Peterson
19 Electrophysiology:Treatment Considerations in Women...........285
Michael S. Bailey and Anne B. Curtis
20 Exercise Training and Cardiac Rehabilitation for Women..........297
Elisa Yuen Man Chiu, Maria Vivina T. Regis, and
Erika Sivarajan Froelicher
21 Menopausal Hormone Therapy: Is There Evidence
for Cardiac Protection? ...........................................................321
Nanette K. Wenger
P IV. E P I
ART CONOMICSAND OLICY SSUES
H C R W
IN EALTH ARE ELATED TO OMEN
22 Gender Bias: Is It Real and How Does It Affect Diagnosis,
Management, and Outcome?....................................................351
Thomas H. Marwick and Jonathan Chan
Contents ix
23 The Role of Women’s Health Centers in Improving Access
and Process of Care..................................................................371
Susan Kendig and D. Douglas Miller
24 Obstetrician/Gynecologists, Primary Care,
and Cardiovascular Disease .....................................................387
William W. Hurd, Sheela Barhan, and Robert E. Rogers
25 Health Technology Assessment in the Era of Managed Care:
Issues in Women’s Health Care...............................................401
Laura Sampietro-Colom, Shawna Jackson, Erin Williams,
and Frank J. Papatheofanis
26 Issues in the Analysis of Cost-Effectiveness
in the Diagnosis and Treatment of Coronary Artery
Disease in Women....................................................................413
Adam Atherly and Steven D. Culler
Index...........................................................................................................................423
C
ONTRIBUTORS
ADAM ATHERLY,PhD, Department of Health Policy and Management, Rollins School
of Public Health, Emory University, Atlanta, GA
MICHAEL S. BAILEY,MD, Division of Cardiovascular Medicine, University of Florida,
Gainesville, FL
SHEELA BARHAN,MD,Department of Obstetrics and Gynecology, Wright State
University School of Medicine, Dayton, OH
ANDRA L. BLOMKALNS,MD, Department of Emergency Medicine, University of Cincinnati
Medical Center, Cincinnati, OH
PAUL R. CASPERSON,PhD, Division of Cardiology, University of Texas Health Science
Center at San Antonio, TX
JONATHAN CHAN,MBBS,Department of Medicine, University of Queensland, Brisbane,
Australia
ELISA YUEN MAN CHIU,RN,MS, Department of Physiological Nursing, School of
Nursing, UCSF, San Francisco, CA
STEVEN D. CULLER,PhD, Department of Health Policy and Management, Rollins
School of Public Health, Emory University, Atlanta, GA
ANNE B. CURTIS,MD, Division of Cardiovascular Medicine, University of Florida
College of Medicine, Gainesville, FL
CHRISTI DEATON,PhD,RN,FAHA, School of Nursing, Emory University, Atlanta, GA
ERIKA SIVARAJAN FROELICHER,RN,PhD,FAAN, Department of Epidemiology and
Biostatistics, School of Medicine, UCSF, San Francisco, CA
W. BRIAN GIBLER,MD,Department of Emergency Medicine, University of Cincinnati
Medical Center, Cincinnati, OH
DARCY GREEN-CONAWAY,MD,Department of Cardiology, University of Missouri-
Kansas City School of Medicine, Kansas City, MO
WILLIAM W. HURD,MD,Department of Obstetrics and Gynecology, Wright State
University School of Medicine, Dayton, OH
SHAWNA JACKSON,MS, Aequitas Consulting Group, San Diego, CA
ALICE K. JACOBS,MD,Evans Department of Medicine, Boston Medical Center, Boston, MA
MARIELL JESSUP,MD,FACC,FAHA, Department of Medicine, University of Pennsylvania
School of Medicine, Philadelphia, PA
B. DELIA JOHNSON,PhD,Epidemiology Data Center, Graduate School of Public
Health, University of Pittsburgh, Pittsburgh, PA
SHERYL F. KELSEY,PhD,Epidemiology Data Center, Graduate School of Public
Health, University of Pittsburgh, Pittsburgh, PA
SUSAN KENDIG,RNC,MSN,WHCNP,Barnes College of Nursing and Health Studies,
University of Missouri-St. Louis, St. Louis, MO
MARVIN A. KONSTAM,MD, Division of Cardiology, Department of Medicine, Tufts-New
England Medical Center, Boston, MA
CHERIE L. KUNIK,MSN,RN,CS,Shepherd Spinal Center, Atlanta, GA
MICHAEL S. LAUER,MD,FACC, Department of Cardiology, Cleveland Clinic Foundation,
Cleveland, OH
xi
xii Contributors
JANE A. LEOPOLD,MD, Evans Department of Medicine, Boston Medical Center,
Boston, MA
THOMAS H. MARWICK,MD,PhD,FRACP,FACC, Department of Medicine, University
of Queensland, Brisbane, Australia
MICHAEL E. MENDELSOHN,MD,Molecular Cardiology Research Institute, Tufts-New
England Medical Center, Boston, MA
C. NOEL BAIREY MERZ,MD, Preventive and Rehabilitative Cardiac Center, Cedars
Sinai Medical Center, Los Angeles, CA
JENNIFER H. MIERES,MD,Division of Nuclear Medicine, North Shore University
Hospital, Manhasset, NY
D. DOUGLAS MILLER,MD,CM,MBA,FACC,FRCP(c), Department of Internal Medicine,
Saint Louis University School of Medicine, St. Louis, MO
DANIEL P. MORIN,MD,MPH, Division of Cardiology, Department of Medicine,
Tufts-New England Medical Center, Boston, MA
ANTHONY P. MORISE,MD, Section of Cardiology, Department of Medicine, West
Virginia University School of Medicine, Morgantown, WV
LORI MOSCA,MD,MPH,PhD,Division of Cardiology and Division of Preventive
Medicine and Nutrition, New York-Presbyterian Hospital, Columbia and Cornell
Universities, New York, NY
SHARON MULVAGH,MD, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
L. KRISTIN NEWBY,MD, Duke Clinical Research Institute, Duke University, Durham, NC
ELIZABETH OFILI,MD, Division of Cardiology, Morehouse School of Medicine, Atlanta, GA
ROBERT A. O’ROURKE,MD, Division of Cardiology, University of Texas Health Science
Center at San Antonio, TX
FRANK J. PAPATHEOFANIS,MD,MPH,PhD, Aequitas Consulting Group and Advanced Medical
Technology Assessment and Policy Program, University of California, San Diego, CA
ERIC PETERSON,MD,FACC, Duke Clinical Research Institute, Duke University, Durham, NC
KIMBERLY J. RASK,MD,PhD,Division of General Internal Medicine, Emory University
School of Medicine, and Department of Health Policy and Management, Rollins
School of Public Health, Emory University, Atlanta, GA
RITA F. REDBERG,MD,FACC, Department of Medicine, University of California School
of Medicine, San Francisco, CA
MARIA VIVINA T. REGIS,RN,MS,Department of Physiological Nursing, School of
Nursing, University of California, San Francisco, CA
VÉRONIQUE L. ROGER,MD,MPH, Division of Cardiovascular Diseases and Internal
Medicine, Mayo Clinic and Foundation, Rochester, MN
ROBERT E. ROGERS,MD, Department of Obstetrics and Gynecology, Indiana University
School of Medicine, Indianapolis, IN
JOHN A. RUMBERGER,PhD,MD,FACC, Division of Cardiology, Department of Medicine,
The Ohio State University, Columbus, OH
LAURA SAMPIETRO-COLOM,MD,MPH, Catalan Agency for Health Technology Assessment,
Barcelona, Spain
LESLEE J. SHAW,PhD,Outcomes Research, American Cardiovascular Research
Institute, Atlanta, GA
CLAIRE E. POTHIER SNADER,MA,Department of Cardiology, Cleveland Clinic Foundation,
Cleveland, OH
