Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For women, when comparing noninvasive testing,which testing method (echocardiography, MIBI-SPECT, pharmacological testing, etc.) is more accurate in diagnosing coronary artery disease.

There has been inadequate studies done on women for this type of investigation. Electrocardiography stree studies have shown to be indeterminate in accurately diagnosing coronary artery disease due to hormonal influences as well as certain women having inability to achieve maximal exertion on treadmill for accurate diagnosis. Nuclear stress testing compared with echocardiographic stress testing has not been adequately compared. Prior studies have demonstrated that women and men show similar sensitivity and specificity for diagnosis when utilizing echocardiography stress methods, but studies have not been conducted specificially on women comparing stress echocardiogrpahy to different nuclear stress methods.

This is an area of research that should have priority so as women can be accurately diagnosed without unnecessary further invasive testing and risks associated with more invasive testing.

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

See above

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Women presenting with chest pain.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

No

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improvement in accurately diagnosing CAD in women to improve overall mortality and risks associated with undiagnosed CAD and subsequent acute coronary events.

Describe any health-related risks, side effects, or harms that you are concerned about.

Stated above

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cardiovascular disease, including stroke and hypertension

AHRQ Priority Populations

• Women

Federal Health Care Program

None

Importance

Describe why this topic is important.

I researched this as a student in graduate school and found thhere to be minimal new evidence to support an implementation or intervention for diagnosing CAD in women.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

I was motivated for this question having worked in the Cardiology Stress Lab testing In- and Out-patient populations. I noticed that studies were frequently dicated as "indeterminate" or "suboptimal." These interpretations were due to attenuation defects by nuclear stres methods or poor image quality obtained from exercise echocardiogrpahy. I also was concernedd with women being treated similar to male patients when there exists research that women's symptoms, quality of care, and number of hospital admissions can be compromised according to gender with the same complaint of "chest pain."

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Stated above

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Provide the best quality of care for women taking into account their difference in biological, physiological, and hormonal influences that prompts their care to be different than of the male population when considering appropriate noninvasive testing for diagnosing CAD.

The AHA has a 2005 guideline discussing noninvasive testing for women but concludes that further research is needed for the newer stress testing methods and comparison of these methods. This guideline states that assessing a woman's pre-CAD risk is what the practitioner should use in determining appropriate selection of noninvasive testing. This is quite unspecific and can be subjective acorss the healthcare realm of care-givers.

Describe the timeframe in which an answer to your question is needed.

This should be a priority with the rising prevalence of CAD in women. This should be on the agenda for urgent research.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Provide the best quality of care for women taking into account their difference in biological, physiological, and hormonal influences that prompts their care to be different than of the male population when considering appropriate noninvasive testing for diagnosing CAD.

The AHA has a 2005 guideline discussing noninvasive testing for women but concludes that further research is needed for the newer stress testing methods and comparison of these methods. This guideline states that assessing a woman's pre-CAD risk is what the practitioner should use in determining appropriate selection of noninvasive testing. This is quite unspecific and can be subjective acorss the healthcare realm of care-givers.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

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