“Matters of the Heart: A Research Journey Uncovering Signs of Heart Disease in Women”


>>WELCOME TO THE NINR’S DIRECTOR’S LECTURES THAT BRINGS TOGETHER THE TOP SCIENTISTS TO NIH CAMPUS TO SHARE THEIR WORK WITH A TRANSES DISCIPLINE AUDIENCE IT IS KNEES TO SEE YOU IN THE AUDIENCE AND RECOGNIZE THAT THIS IS BEING VIDEOCAST AND WE ARE PLEASED WITH THE TURNOUT ON THAT AS WELL. IT PROVIDES FOR AN OPPORTUNITY FOR EXCHANGE OF IDEAS ACROSS SCIENCE ENTIRE NIH RESEARCH COMMUNITY. THIS IS THE THIRD LECTURE OF 4 WE WILL HAVE IN 2019 THIS WILL ALSO BE AVAILABLE ON NINR’S YOUTUBE CHANNEL WHO STRIVE TO ACCELERATE NURSING SCIENCE AND WHICH NINR SUPPORT AND SCIENCE CAN HAVE THE LARGEST IMPACT. I’M ANNE CASHIN ACTING DIRECTOR FOR NINR I’M TO WELCOME JEAN MCSWEENY. NITY
– ACROSS ALL CARE SETTINGS IT BRINGS SCIENCE AND EVIDENCE-BASED HEALTHCARE INTO PEOPLE’S DAILY LIVES. WE SUPPORT RESEARCH THAT SERVES A PIVOTAL ROLE THAT INTEGRATE BEHAVIORIAL SCIENCE AND INVESTIGATE SYMPTOM SCIENCE SELF-WELLNESS AND MANAGEMENT AND WE PROMOTE RESEARCH THAT PROMOTES LONG-TERM HEALTH INCLUDING HEALTHY BEHAVIORS THAT PREVENTS ILLNESS AND COMORBIDITIES AND EVIDENCE-BASED PERSONALIZED INTERVENTIONS THAT PROMOTES WELLNESS OF INDIVIDUALS ACROSS POPULATIONS IN EFFORTS TO PERSONALIZE HEALTH AND PROMOTE WELLNESS. NINR ADDRESSES WOMEN’S HEALTH THROUGH WIDE RANGE OF TOPICS THAT EFFECT MEN AND WOMEN DIFFERENTLY. THIS IS THE THEME OF TODAY’S PRESENTATION. CORONARY HEART DISEASE IS A CONDITION THAT CONTINUES TO BE UNDERRECOGNIZED IN WOMEN. EARLY DETECTION AND DIAGNOSIS OF CORONARY HEART DISEASE IS CHALLENGING. WOMEN EXPERIENCE SYMPTOMS DIFFERENTLY THAN MEN. NOVEL AND SENSITIVE DIAGNOSTIC INTERVENTIONS THAT DELIVER TAILORED CARE AND REAL-TIME INFORMATION TO PATIENTS FAMILIES AND COMMUNITIES. TODAY’S SPEAKER JEAN MCSWEENY EXEMPLIFIES NURSE SCIENCE AND RECOGNIZES GENDER AS IMPORTANT FACTOR TO BE CONSIDERED ESPECIALLY IN ERA OF PERSONALIZED APPROACHES OF HEALTH. SHE IS ASSOCIATE DEAN OF RESEARCH AT UNIVERSITY OF ARKANSAS IN NURSING LITTLE ROCK. SHE IS MORE THAN THAT. WE HAVE KNOWN EACH OTHER SINCE I WAS THERE ON FACULTY AT UNIVERSITY OF ARKANSAS. SHE HAS BEEN A MENTOR TO ME AND WARM AND RECEPTIVE INDIVIDUAL AT EVERY POINT. I WAS SO PROUD OF HER WHEN HER RESEARCH WAS ONE OF THE FIRST TO ARE REALLY DOCUMENT DIFFERENCES IN GENDERS IN TERMS OF SYMPTOMS RELATED TO CORONARY HEART DISEASE T IS A PRIVILEGE TO BE HERE AND HAVE THIS OPPORTUNITY. SHE IS A RESEARCH PIONEER IN THESE AREAS. IN ADDITION TO THOSE AREAS, DR. MCSWEENY STUDIED PSYCHATIC DISORDERS AND STRESS IN VETERANS FOCUSING ON RIFSHG FACTOR MODIFICATION. DR. MCSWEENY SERVED ON NINR ADVISEE COUNCIL AND NIH COUNCIL OF COUNCILS SHE PROVIDES GUIDANCE FOR NIH AND IS FELLOW OF AMERICAN HEART ASSOCIATION AND ACADEMY OF NURSING AND WON NUMEROUS AWARDS INCLUDING AMERICAN HEART ASSOCIATIONS KATHARINE A. LEMBRIGHT AWASHD. SHE — TODAY, SHE WILL BE SPEAKING TO US ABOUT MATTERS OF THE HEART, A RESEARCH JOURNEY UNCOVERING SIGNS OF HEART DISEASE IN WOMEN. SHE WILL BE SPEAKING FOR ABOUT 30 MINUTES AFTER WHICH SHE WILL HAVE AN OPPORTUNITY TO DO QUESTIONS AND ANSWERS. THANK YOU MUCH. >>AUDIENCE: [APPLAUSE]. >>THANK YOU VERY MUCH, ANNE. I WANT TO THANK YOU FOR BEING HERE. I CAN’T SEE FACES WITH LIGHTS IN MY EYES. THERE ARE FAMILIAR FACES HERE AND I THANK YOU VERY MUCH FOR BEING HERE. >>AUDIENCE: [LAUGHING]. >>IT IS MY PRIVILEGE TO BE HERE AND TALK ABOUT MY PASSION FOR THIS RESEARCH. IT HAS INDEED BEEN A LONG JOURNEY. I WANT TO START WITH THE HISTORY A LITTLE BIT AND I HAVE TO LAY THE GROUNDWORK SO YOU UNDERSTAND WHAT I WAS UP AGAINST WHEN I BEGAN THIS JOURNEY. HEART DISEASE WAS CONSIDERED IN THE 50S MUCH MORE OF A SIGNIFICANT PROBLEM IN MEN THAN IN WOMEN. FDA GUIDELINES ESSENTIALLY SCLUDED WOMEN FROM CLINICAL TRIALS BECAUSE OF FLUCTUATING HORMONE LEVELS AND IN CLINICAL TRIALS IN 1993 WE BEGAN TO SEE MORE WOMEN INCLUDED IN RESEARCH. IF YOU HAVE THAT IN MIND THAT THERE WAS NO RESEARCH REALLY BEING CONDUCTED WITH WOMEN AND HEART DISEASE AND LOOK BACK AT 1979 WHICH WAS LATEST OR EARLIEST RATHER THAT I COULD FIND STATISTICS FOR THIS AND MEN AND WOMEN WOMEN ARE IN RED AND MEN IN BLUE RESEARCH BENEFITS MEN. WE HAD SIGNIFICANT DROPS IN MORTALITY RATES. IT DIDN’T BENEFIT WOMEN. THEIR MORTALITY RATES CONTINUED TO DECLINE. THIS IS THE ENVIRONMENT I STARTED MY RESEARCH IN. VERY FIRST STUDY OF WOMEN’S AWARENESS OF HEART DISEASE OF CAUSE OF DEATH WAS IN ’97. ONLY WHITE WOMEN AT 33% IDENTIFIED THIS AS A MAJOR HEALTH RISK FOR THEM AND VERY POOR SHOWING OF MINORITY WOMEN ARE AFRICAN-AMERICAN WOMEN AND HISPANIC WOMEN. I DID A FIRST QUALITATIVE STUDY EXPERIENCING HEART DISEASE. I WASN’T INTERESTED IN SYMPTOMS WOMEN HAD WITH THIS STUDY. I TRIED TO HELP WOMEN MAINTAIN BEHAVIOR CHANGES. I THOUGHT IF I COULD IDENTIFY WHAT THEY THOUGHT CAUSED THEIR MRI AND RELATE THEIR BEHAVIOR CHANGES TO IT, THEY MIGHT BE MORE LIKELY TO BE ABLE TO MAINTAIN HEALTHY BEHAVIOR CHANGES. THIS STUDYI WAS FUNDED BY AMERICAN HEART ASSOCIATION AND DESCRIPTIVE STUDY OF 20 WOMEN AND DURING THE COURSE OF THE STUDY ALTHOUGH I HAVE ANSWERS TO MY RESEARCH QUESTIONS, IT BECAME VERY OBVIOUS TO ME THAT WOMEN WERE HAVING DIFFERENT SYMPTOMS AND HAD GREAT DIFFICULTY GETTING DIAGNOSED WHEN THEY HAD THESE SYMPTOMS BEFORE THEY MI. IT BECAME THE FOCUS OF MY NEXT STUDY. STUDENTS THAT MIGHT BE IN THE AUDIENCE, PAY ATTENTION TO THIS AND YOUNG RESEARCHERS. SOMETIMES WHAT YOU FIND THAT IS THE MOST IMPORTANT FINDING IS NOT WHAT YOU SET OUT TO FIND. MY NEXT STUDY WAS ALSO A QUALITATIVE STUDY FUNDED BY AMERICAN HEART ASSOCIATION THAT SPECIFICALLY LOOKED AT SYMPTOMS. I INTERVIEWED 60 RACIALLY DIVERSE WOMEN THAT REFLECTED BACK ON SYMPTOMS THEY HAD SURROUNDING THEIR MIS. FIRST STUDY INDICATED TO ME I NEEDED TO LOOK AT MORE THAN JUST ACTUAL ACUTE EVENT. WOMEN TALKED ABOUT SYMPTOMS THAT OCCURRED BEFORE THEIR EVENT. I FOCUSED ON THE TIME AND ONSET OF SYMPTOMS, THEIR FREQUENCY, SEVERITY, AND WORDS THEY USED TO DESCRIBE. WE WERE INITIATING A LOT OF CHECKLISTS WE CONTINUE TO USE. THE MOST IMPORTANT WORD ON THE CHECK LIST WHEN WOMEN GO TO THE EMERGENCY DEPARTMENT IS CHEST PAIN. OFTEN TIMES I DID NOT USE THAT WORD. I WANTED TO CAPTURE THE WORDS THAT THEY WERE USING. SO AS A RESULT OF THIS STUDY, WE IDENTIFIED PRODROEMAL SYMPTOMS. WOMEN IDENTIFIED IT. I JUST ANALYZED IT. THESE ARE SYMPTOMS THAT COME AND GO PRIOR TO AND CHANGE AFTER THE MI. THEY WERE A NEW ONSET THAT WOMEN HAD NEVER HAD THESE SYMPTOMS BEFORE. IF THEY HAD THEM BEFORE, THEY INCREASING INTENSITY AND/OR FREQUENCY OF EXISTING SYSTEMS IMPORTANT THING THEY DISAPPEARED AFTER THE MI OR REFERRED BACK TO PREVIOUS LEVELS. THIS IS A COUPLE QUOTES TO GIVE YOU AN IDEA WHAT WOMEN SAID AND HOW I PICKED OUT SYMPTOMS THEY HAD. THIS TERRIBLE LETHARGY OR FATIGUE ENDED UP BEING A VERY IMPORTANT SYMPTOM. YOU CAN SEE HOW SEVERE THIS IS AT ITS MOST SEVERE WHEN THIS WOMAN COULDN’T EVEN MAKE A BED WITHOUT SITTING DOWN TO REST. THIS WOMAN SAID 4 TO 6 MOS. THIS IS WHERE SURROUNDING SYMPTOMS CAME IN. THIS WAS BEFORE THE MI THAT SHE HAD SHORTNESS OF BREATH AND HACKIE COUGH AND FLU-LIKE SYMPTOMS NOT FEELING WELL. ACUTE SYMPTOM IDENTIFICATION AND DEFINITION WAS MORE TRADITIONAL. THESE WERE SYMPTOMS THAT PERSIST OR INTENSIFY LEADING TO DIAGNOSIS OF MI. ONCE PRESENT, THEY REMAINED UNTIL THEY WERE ACTUALLY TREATED FOR THESE SYMPTOMS. HERE IS AN EXAMPLE OF A WOMAN AND I WANT YOU TO IMAGINE A WOMAN COMING INTO E DATA DEPARTMENT AND THIS IS WHAT SHE DESCRIBED THAT SHE WAS EXPERIENCING AT THIS POINT IN TIME AND HOW MANY OF US WOULD HAVE DIAGNOSED HER AS HAVING AN MI. SO ANXIETY. HER ARMS WERE STARTING TO FEEL WEAK, NO INTENSE PAIN. IT WAS LIKE A MUSCLE ACHE. THIS WOMAN WENT ON TO SAY IT WASN’T EVEN BAD ENOUGH TO TAKE A TYLENOL. SHE WAS ACTUALLY HAVING AN MI. THIS WOMAN WAS A BIT MORE TRADITIONAL AND DIDN’T EXPERIENCE WHAT SHE CALLED PAIN IN HER CHEST INSTEAD IT WAS COMING AROUND FROM HER BACK WHERE SHE THINKS THE SHOULDER BLADE AREA IS. ONCE I COMPILED ALL OF THESE SYMPTOMS TOGETHER, I LOOKED FOR INSTRUMENTS. I THOUGHT THIS IS VERY IMPORTANT. WE NEED TO GET LARGER SAMPLES. I LOOKED AT TWO EXISTING QUESTIONNAIRES THAT WERE OUT AT THAT POINT IN TIME. NEITHER CAPTURED WOMEN’S MOEFT FREQUENT SURPRISE TO ME I WOULDN’T HAVE IMAGINED I WOULD DO INSTRUMENT DEVELOPMENT: THAT IS WHERE THE COURSE TOOK ME. IT WAS IMPORTANT TO ME TO FOLLOW UP ON THIS. I COMPILED PRODROEMAL AND ACUTE SYMPTOMS AND DESCRIPTORS AND SURVEY EXPERTS AROUND CONTENT EXPERTS. WE DID A VARIETY OF TESTS. THIS TOOK ALMOST TWO YEARS TO GET THIS TOTALLY PUT TOGETHER. YOU CAN SEE SOME DIFFERENT STUDIES THAT WENT INTO DEVELOPING THIS INSTRUMENT. AT THE TIME INITIALLY, IT HAD 37 ACUTE AND 33 PRODROEMAL SYMPTOMS AFTER WE DID OUR RELIABILITY AND VALIDITY TESTING, WE DECREASED THAT NUMBER SLIGHTLY. FINAL MAP MESS CONTAINED 30 PRODROEMAL SYMPTOMS WEIGHTED BY SEVERITY AND FREQUENCY AND INDIVIDUAL SCORES COUD RANGE FROM 0 TO 21 AND WE SUMMED THESE TO OBTAIN OVERALL PRODROMAL SCORE. IT HAS EXCELLENT CONTENT VALIDITY AND TEST RELIABILITY WITH BOTH BLACK AND CAUCASIAN WOMEN. NEXT I PROCEEDED TO DO A SERIES OF R01S. I’M THANKFUL TO NATIONAL INSTITUTE OF NURSING RESEARCH FOR FUNDING THESE STUDIES. I WILL BE ETERNALLY GRATEFUL. WE IMPACTED LOTS OF WOMEN’S LIVES BECAUSE OF THIS FUNDING. FIRST STUDY, I COMBINED TWO OF THESE TOGETHER TO REPORT ON WAS TO DESCRIBE WOMEN’S PRODRO AMAL AND ACUTE SYMPTOMS. I WANTED TO LOOK AT WOMEN AND LOOK AT THE MAJORITY OF WOMEN THAT WERE LOCATED IN THE STATES I WOULD BE SEEKING MY SAMPLE. I WANTED TO SEE IF THE SYMPTOMATOLOGY DID INDEED VARY BY ETHNICITY AND RISK STATUS AND RECRUITED FROM 15 SITES NATIONWIDE. THE ONE SITE HERE DOESN’T TELL YOU IT TOOK ME ALMOST A YEAR TO GET 15 SITES TOGETHER. WHEN WE HAD 15IRBS FOR 15 SITES. IT TOOK A LOT OF ENERGY AND DERMENT NATION AND ORDER TO MAKE THIS WORK. MEDICAL CENTER PERSONNEL CONFIRMED DISCHARGE DIAGNOSIS AND CONTACTED MEN AND WOMEN AND GOT INITIAL PERMISSION FOR US TO CONTACT THEM. WE CONTACTED THEM AFTER 2 MONTHS FOR DISCHARGE. 43 WOMEN ALREADY DIED AFTER DISCHARGE FROM THE HOSPITAL WITH CARDIOVASCULAR DISEASE AND WE DID 78% OF ELIGIBLE WOMEN AND FINAL SAMPLE WAS 1270. IT WAS A STRUCTURED TELEPHONE SURVEY COMPLETED 4 TO 6 MONTHS AFTER THE MI. I HAD TO JUSTIFY THAT. I JUSTIFIED THAT BECAUSE PROD-DROMAL SYMPTOMS WOULD DISAPPEAR OR RETURN TO PREVIOUS LEVELS AFTER MI. WE HAD TO HAVE TIME TO RECOGNIZE SYMPTOMS THAT INDEED CHANGED. CONTENT ON MAP MESS IS SYMPTOMS AND COMORBIDITY RISK FACTORS DATA INDIRECTLY INTO DATA ACCESS BASE AND 26 ASSISTED TELEPHONE INTERVIEWS AND BEAUTY OF THIS IS RESEARCH ASSISTANTS COULDN’T GO TO NEXT PAGE ON THE SCREEN UNTIL EVERYTHING WAS COMPLETED SO WE HAD NO MISSING DATA FOR THE STUDIES. THIS IS AN EXAMPLE WHAT ONE OF THE SCREENS LOOKED LIKE FOR RESEARCH ASSISTANTS AS THEY ASKED WOMEN QUESTIONS. FOR THE SAMPLE FOR THIS PARTICULAR — THESE TWO STUDIES, THE WHITE WOMEN WERE SIGNIFICANTLY OLDER THAN OUR — THAN BLACK WOMEN NOT HISPANIC WOMEN. THEY WERE MORE EDUCATED. INDIVIDUAL INCOMES YOU CAN SEE WERE VERY LOW. THIS GIVES YOU MORE OF A DESCRIPTION. WE DIDN’T END UP WITH APPROXIMATELY EQUAL NUMBERS OF WHITE AND BLACK WOMEN THAT DID NOT DO AS WELL WITH HISPANIC WOMEN WHICH I STILL MOURN THAT. I WISH WE WERE ABLE TO DO MORE ANALYSIS WITH. THAT YOU CAN SEE WOMEN WERE PRIMARILY OLDER AND HYPERTENSION. LOOK AT BMI WAS A VERY IMPORTANT RISK FACTOR HERE. LOOK AT DIFFERENCE BETWEEN AFRICAN-AMERICAN WOMEN AND CHOLESTEROL LEVELS WERE ALSO VERY HIGH ACROSS THE BOARD. THESE WERE THE 5 MOST PREEK WENT PRO-DROMAL FACTORS AND STAGGERS INDICATE DIFFERENCES HERE AS YOU LOOK AT THE SLIDES. NO DIFFERENCES WITH FATIGUE NO. 1 SYMPTOM THAT UNUSUAL FATIGUE I TOLD YOU ABOUT IT THAT WE PICKED UP ON QUALITATIVE INTERVIEWS. SLEEP FEELINGS OF ANXIETY, SHORTNESS OF BREATH AND FREQUENT INDEJESTON. WE HAD DIFFERENCES BY RACE AS YOU CAN SEE. 5 MOST FREQUENT ACUTE SYMPTOMS NO CHANGES OR SIGNIFICANT DIFFERENCES RATHER WITH SHORTNESS OF BREATH AND TYPICALLY NO. 1 SYMPTOM THAT BRINGS WOMEN TO THE EMERGENCY DEPARTMENT. WE COMBINE DESCRIPTORS OF CHEST OR DISCOMFORT WHETHER IN THE BACK OR CHEST OR WHATEVER TO HELP DIAGNOSTICALLY SINCE WOMEN WERE HAVING SO MUCH TROUBLE GETTING DIAGNOSED WHEN THEY WENT TO THE ED. I WANTED TO FIND OUT WHAT WOULD HELP OUR CLINICIANS THE MOEFRT TO BE ABLE TO RECOGNIZE THIS. WHEN WE COMBINED ALL LOCATIONS FOR ACUTE, IT DID BECOME A SIGNIFICANT — ONE OF THE 5 MOST FREQUET ACUTE SYMPTOMS. FEELING WEAK, FATIGUE, AND FEELING DIZZY ROUNDED OUT THE TOP 5. AGAIN, DIFFERENCES BY RACE. OVER 95% OF THE WOMEN EXPERIENCED PRODROMAL SYMPTOMS WITH FATIGUE AS 1. AFRICAN-AMERICAN WOMEN HAD HIGHEST NUMBER OF INTENSITY OF PRODROMAL SYMPTOMS GENERAL SYMPTOMS. WHITE WOMEN HAD LEAST NUMBER OF SYMPTOMS OF ALL AND CHEST PAIN DISCOMFORT WASN’T A FREQUENT PRODROEMAL SYMPTOM AS OFTEN TIMES AJIENA IS IN MEN. ACUTE SYMPTOMS MINORITIES HAD ACUTE SYMPTOMS THAN MEN WITH SHORTNESS OF BREATH. 21 OF 37 ACUTE SYMPTOMS THIS IS WHAT GARNERED MOST ATTENTION AND GOT WORLDWIDE ATTENTION 42% OF WHITE 37 BLACK AND 2 SEVEN% HISPANICS REPORTED NO ACUTE CHEST DISCOMFORT DURING MI. CLINICAL NURSE WITH ACUTE BACKGROUND, I REALLY WANTED TO KNOW WHAT WOMEN WERE HAVING THESE SYMPTOM AND HOW DID THEY CLUSTER TOGETHER. TOOK A WHILE TO FIND A STATISTICIAN TO DO CLUSTER ANALYSIS IN METHOD I WANTED TO GET IT DONE I WILL REPORT ON KMINE BRIEFLY AND WE REMOVED SYMPTOMS PRIOR TO CLUSTERING. THREE NATURALLY OCCURRING CLUSTERS FOR PRODOMAL ACUTE SYMPTOM SETS WITH INCREASING FREQUENCY AND SEVERITY OF SYMPTOMS. QUICKLY, I WILL GO THROUGH THIS. I WANT YOU TO SEE CLUSTER ONE ONLY MEDIUM PROBABILITY THAT SHOULD BE 40 TO 69% RATHER THAN 70%. EXCUSE THAT, PLEASE. WAS A VERY TIRED UNUSUAL FATIGUE THAT YOU CAN SEE CLUSTER 2. CLUSTER 1 HAD THE MOST WOMEN IN IT. CLUSTER 2, WE BEGAN TO SEE HIGH PROBABILITY SYMPTOMS OCCURRING. CLUSTER 3, LOOK AT THE NUMBER OF SYMPTOMS THEY HAD BOTH MEDIUM PROBABILITY AND HIGH PROBABILITY. SO WE HAVE GOT THE CLUSTERED TOGETHER. I WANTED TO KNOW ALSO ABOUT THE ACUTE SYMPTOM CLUSTERS. HERE WE GO AGAIN. MOST ARE IN NUMBER — CLUSTER NO. 1. THIS IS ANY CHEST PAIN DISCOMFORT AND SHORTNESS OF BREATH. WE BEGAN TO PICK UP MOR SYMPTOMS IN CLUSTER NO. 2. QUITE A FEW MEDIUM PROBABILITY SYMPTOMS AND SHORTNESS OF BREATH AS HIGH PROBABILITY SYMPTOM. CLUSTER NO. 3, AGAIN, IT THIS IS A SMALLER NUMBER, 248 OF THE WOMEN BUT LOOK AT THE NUMBER OF SYMPTOMS THEY ARE HAVING. NOW, WHO IS IN THE SYMPTOMS, S THESE CLUSTERS? 6 OF 10 CHARACTERISTICS WERE STRONGLY ASSOCIATED WITH THE CLUSTERS. YOU CAN SEE AGE, RACE, BMI PRIMARILY. BMI WAS THE MOST IMPORTANT FACTOR IN CLASSIFYING PRODROEMAL SYMPTOMS FOLLOWED BY RACE AND SMOKING AS YOU WOULD EXPECT. 41% OF YOUNG OBESE BLACK AND HISPANIC WOMEN WERE IN CLUSTER 3. REMEMBER THE SYMPTOMS THEY HAD BOTH HIGH AND MODERATE PROBABILITY IN THESE CLUSTER NO. 3. REMEMBER THIS BECAUSE AS I GET TO LATER STATISTICS, YOU WILL SEE WE ARE STILL NOT DOING A GOOD JONG WITH OUR YOUNG MINORITY WOMEN. AGE IS MOST IMPORTANT FACTOR CLASSIFYING ACUTE SYMPTOMS FOLLOWED BY RACE. 47% OF BLACK WOMEN WERE IN CLUSTER 3 QUITE A FEW OF THEM ALMOST HALF WERE IN THIS CLUSTER. NEXT STUDY AGAIN WAS FUNDED BY NINR. ALL THE STUDIES HAD BEEN RETROSPECULATIVE I WANTED TO USE THE INSTRUMENT PROSPECTIVELY TO PICK UP WOMEN AND DETERMINE INDEED IF THEY WOULD GO ON AND HAVE AN MI. THIS WAS LONGITUDINAL OBSERVATIONAL STUDY FOLLOWED WOMEN FOR TWO-YEAR PERIOD AND ASSESS EXTENT TO MAP SCORE TO PREDICT CHD EVENTS. THIS IS HOW WE DEFINE EVENTS AND WANT TO SEE IF IT IDENTIFIED MOST PREDICTIVE COMPONENTS OF MAP MESS PRODROEMAL SURVEY. WE FOCUS PRIMARILY ON BLACK AND WHITE WOMEN DIFFICULTY GETTING HISPANIC WOMEN. HOPING SOMEONE WILL FOLLOW UP ON THIS REFERRED TO CARDIOVASCULAR EVALUATION NO KNOWN CHD AT THIS TIME. THEY WOULD GET CLEARED FOR SURGERY. SOME WITH BASELINE AND SOME WERE REFERRED FROM FAMILY PRACTICE. 21 YEARS OF AGE OR OLDER AND COGNITIVELY IN TACT. COHORT HAD A LITTLE OVER 1100 WOMEN IN THIS DIDN’T DO AS WELL WITH AFRICAN-AMERICAN WOMEN RECRUITING WITH THIS PARTICULAR STUDY AS I HAD HOPED FOR. YOU SEE THE BREAKDOWN. LOOK AT OVERWEIGHT AND OBESE. WE HAD A VERY LARGE COHORT THAT WERE OVERWEIGHT AND OBESE. NOT AS MANY WITH DIABETES THAT I WOULD HAVE EXPECTED. MOST HAD A FAMILY HISTORY. FOR THE RESULTS, 77 WOMEN DURING COURSE OF THIS STUDY EXPERIENCED AN EVENT. WE ALSO DURING TWO-YEAR FOLLOWUP, COMMON EVENTS WERE STINTS ALONE OR IN COMBINATION WITH ANGIOMRAFTY. 10 WOMEN HAD MI AND EXPERIENCED CARDIAC DEATH. PRODROEMAL SCORE WAS SIGNIFICANTLY ASSOCIATED WITH RISK OF AN EVENT. LOOKED AT TOP 5 PRODROEMAL SYMPTOMS OF WOMEN WITH CHD AND THOSE THAT DIDN’T HAVE EVENT DURING COURSE OF THE TWO YEARS YOU SEE WE HAVE SIGNIFICANT DIFFERENCES HERE BETWEEN THE TOP 5 SYMPTOMS. SO OUR RESULTS, 5 SYMPTOMS WERE SIGNIFICANTLY ASSOCIATED WITH INCREASED RISK. THEY ARE DISCOMFORT IN JAWS AND TEETH UNUSUAL FATIGUE ARM DISCOMFORT AND SHORTNESS OF BREATH AND GENERALIZED CHEST DISCOMFORT. WOMEN REPORTING 1 OF 4 STRONGEST PREDICTORS WERE 4.40 TIMES LIKELY TO HAVE ADVERSE CARDIAC EVENT AS WOMEN NOT REPORTING ANY OF THE SYMPTOMS AND WANT TO LOOK AT SENSATIONES WOMEN USE TO AGAIN IMPROVE DIAGNOSTIC WORKUPS OF WOMEN WHEN THEY DO EXPERIENCE AN MI. YOU CAN SEE WORDS THEY USE AND LOOK AT ACHE AND BURNING AND PRESSURE AND SHARPNESS AND SORENESS. CHECKLIST TO THIS DAY PRIMARILY HAVE CHEST PAIN AS INDICATOR AS EXPERIENCING MI OR DIAGNOSTIC WORKUP. CRUSHING EXPECT 10% WITH MI ACTUALLY REPORTED CRUSHING TEST MAIN. MAP MESS, WE TEND TO THINK ABOUT CARDIOVASCULAR DISEASE IN AMERICA BECAUSE OF ALL RISK FACTORS WE HAVE. WHEN THIS RESEARCH AS THIS RESEARCH EVOLVED AND CONTINUES TO THIS DAY, IT IS INCREASING THROUGHOUT THE WORLD. WE STILL GET REQUESTS ABOUT ONCE A MONTH OR SO IN ORDER TO USE THE MAP MESS THROUGHOUT THE WORLD. AT LEAST IN 6 LANGUAGES FARCY SWEDISH CHINESE SO VARIETY OF DIFFERENT COUNTRIES. WE HAD IT IN 10 COUNTRIES. 10 INCLUDING THE UNITED STATESES. SOME OF THE STATES ARE LISTED HERE. NEXT, I WANTED TO SAY THAT I WAS VERY PLEASED REIGN ROSENFELD AND I CO-CHAIRED FIRST AMERICAN HEART ASSOCIATION SCIENTIFIC STATEMENT EVER ON WOMEN AND ISCHEMIC HEART DISEASE THAT WAS PUBLISHED IN 2016 NOT LONG AGO WE HAVE WORKED THROUGHOUT THE TIME PERIOD TRYING TO MAINTAIN FCUS ON CARDIOVASCULAR DISEASE AND WOMEN. IN THE SCIENTIFIC STATEMENT WE MADE VERY SPECIFIC RECOMMENDATIONS THAT CONTINUE TO BE UNNEEDED. WE MUST ADEQUATELY POWER CLINICAL TRIALS BY SEX AND GENDER TO ALLOW ANALYSIS IN REPORTING SEX-SPECIFIC DIFFERENCES. MANY OF THE STUDIES CONTINUE TO BE UNDERPOWERED IN WOMEN AND WE STILL CAN’T ANALYZE BY GENDER. WE MUST MAKE MORE OF AN ATTEMPT TO USE COMMON DATA ELEMENTS TO ALLOW DATA SHARING ACROSS STUDIES TO REALLY ANALYZE TREATMENT EFFECTS. WE SHOULD BROAD ENINCLUSION CRITERIA THAT FOCUS ON HEART DISEASE TO INCLUDE MORE THAN CHEST PAIN. LOOK CLOSELY AT STUDIES BEING DONE WITH ACUTE — ANY KIND OF ACUTE ISCHEMIC EVENT MANY TIMES INCLUSION CRITERIA STATES THEY MUST HAVE REPORTED OR DOCUMENTED ACUTE CHEST PAIN. WE CAN BE EXCLUDING MANY WOMEN FROM THE STUDIES THAT SHOULD INDEED BE IN THEM AND TEST INTERVENTIONS TAILORED FOR WOMEN AND WOMEN OF DIFFERENT ETHNICITIES. WHERE DO WE COME IN THIS LENGTH OF TIME SINCE WE HAVE BEEN DOING OUR RESEARCH AND MANY OTHER PEOPLE? I DON’T TAKE CLAIM FOR THIS. OURS WAS ONE OF MANY GOOD NURSE RESEARCH EVERY DZ AND OTHER RESEARCHERS IT THAT CONTRIBUTED TO DECLINE AND MORTALITY RATES. CONCERNING AS YOU WILL SEE IN 2015 AND 2014, MORTALITY RATES BEGIN TO GO BACK UP AGAIN FOR BOTH MEN AND WOMEN. THIS IS A CONCERN. ONE OF THE MAJOR CONCERNS I HAVE IS BURIED IN OUR DECLINING RATES AND BURIED IN THE CURVE AT THE VERY END AS YOUNG MINORITY WOMEN HAVE NEVER HAD THE BENEFIT THAT WHITE WOMEN HAVE HAD. LOTS OF THE MORTALITY RATES ARE HIDDEN WITHIN THE STATISTICS BECAUSE THE OTHER PEOPLE, OTHER WOMEN’S RATES HAVE DROPPED SIGNIFICANTLY. WE MUST PAY MORE ATTENTION TO OUR MINORITY WOMEN AND YOUNGER AGE GROUPS THAT HAVE HIGH MORTALITY RATE WITH THIS DISEASE. SO WE — OUR LAST AWARENESS, HOW — TO SEE IF WOMEN CONTINUE TO BE AWARE AROUND 2003 AND 2006 SHTHS WE DID MASSIVE RED DRESS CAMPAIGNS TRYING TO INCREASE WOMEN’S AWARENESS. YOU SEE WE HAD GOOD RESULTS WITH THAT. OF CONCERN, 2012, MINORITY WOMEN WERE ONLY WHERE WHITE WOMEN WERE AT 1997 APPROACHING THOSE LEVELS. WE HAVE A LONG WAY TO GO WITH THE DISEASE THAT HAS HIGH DISABILITY AND HIGH MORTALITY RATES IN OUR MINORITY WOMEN. WE ARE JUST COMPLETING THE MOST RECENT SURVEY AND LOOKING AT FINAL ADDITION AT ITS RIGHT NOW. IT SHOULD COME OUT END OF THIS YEAR OR BEGINNING OF THIS YEAR SO STAY TUNED FOR THAT. MOST RECENT FACTS ABOUT WOMEN AND CHD SYMPTOM ONSET IS MORE GRADUAL AND MAY BE MISTAKEN FOR INDIGESTION AND MUSCLE ACHES. COMMON OCCURRENCE THAT CONTINUE TO EXPERIENCE MORE CHARACTERISTIC SYMPTOMS. WOMEN ARE LESS LIKELY THAN MEN TO RECEIVE EKG WITH 10 MINUTES ARRIVAL OF EKG AND LEVELS OF PROPOEN ANYONE. OFTEN TIMES AFTER TWO OF THE TROPE OWN ANYONES COMING BACK NORMAL WOMEN MUST BE SENT HOME. WE MISS THE THIRD IS THAT MAY BEGIN TO SHOW IN ELEVATION. WOMEN FREQUENTLY HAVE SMALL VESSEL DAMAGE THAT MAY BE MISSED BY ANGIOGRAPHY I STRESS THIS LESS LIKELY TO BE INCLUDED IN CLINICAL TRIALS AND RECEIVE POST MI TREATMENTS. I WILL TELL YOU STUDY CAME OUT THIS WEEK THAT LOOKED AT WOMEN WITH HEART FAILURE. IT SAID THAT THE RESULTS OF THE STUDY. SORRY. I DON’T HAVE SLIDES WITH IT AND CAN’T ACKNOWLEDGE THE RESEARCHER INDICATED THAT WOMEN COULD RECEIVE HALF OF THE DOSE THEY ARE RECEIVING RIGHT NOW AND RECEIVE BENEFIT FOR HEART FAILURE TREATMENT. WE HAVE A LONG WAY TO GO CONTINUING TO TREAT WOMEN. WE ALSO I WAS FORTUNATE ENOUGH TO COAUTHOR — IT MADE ME ACUTELY AWARE OF PROBLEM THAT THIS IS WORLDWIDE. PEOPLE IN DEVELOPING COUNTRIES HAD MORE SOCIO ECONOMIC AND HEALTH RISK FACTORS IN CBD. WOMEN ELSEWHERE ARE RURAL WOMEN HIGHER MORTALITY RATES URBAN AND BLACKS HIGHER MORTALITY RATES THAN WOMEN IN — OFTEN TIMES NO INSURANCE COVERAGE AND RURAL AREAS HAVE LONGER TRANSPORT TIME IF THEY ARE ABLE TO ACCESS EMERGENCY TRANSPORT. THERE ARE TREATMENT DIFFERENCES THAT REMAIN BY ETHNICITY. RURAL WOMEN ARE LESS LIKELY TO RECEIVE RECOMMENDED CARDIOVASCULAR MEDICATIONS. IN SUMMARY, I WANT TO SAY LISTENING TO WOMEN GUIDED THIS RESEARCH IN QUALITATIVE AND DESCRIPTIVE RESEARCH OFTEN TIMES IS UNDERVALUED WHEN WE LOOK AT CLINICAL TRIALS. WITHOUT THE FOUNDATION BUILT THROUGH LISTENING AND THROUGH QUALITATIVE STUDIES, WE MAY LACK INSIGHT TO DESIGN INTERVENTIONS THAT EFFECTIVELY ADDRESS THE PROBLEM. IF YOU DO CLINICAL TRIALS AND NOT GETTING GOOD RESULTS OR TRYING VARIOUS INTERVENTIONS NOT WORKING, MAYBE WE NEED TO GO BACK AND FIGURE OUT WHY THEY ARE NOT WORKING AND LISTENING TO PEOPLE MIGHT ACTUALLY GIVE US CLUES AS THESE WOMEN INCLUDE ME IN ON HOW TO REALLY LISTEN TO THEM AND DEVELOP A WAY TO HELP THEM. OBVIOUSLY, RESEARCH IS NEVER DONE ALONE. THIS IS A PARTIAL LIST OF SOME OF THE RESEARCH ASSISTANCE AND OTHER FACULTY MEMBERS WHO HAVE HELPED ME. IT IS OHM PARTIAL. I COULDN’T FIT THEM ALL ON ONE SLIDE. I DO VERY MUCH — I’M GRATEFUL TO ALL OF THEM TO NATIONAL INSTITUTE OF NURSING RESEARCH AND AMERICAN HEART ASSOCIATION AND TO MY HUSBAND SITTING IN THE AUDIENCE HERE FOR PUTTING UP WITH MY LONG HOURS AND DEVOTION TO THIS RESEARCH. I THANK YOU VERY MUCH. I’M READY TO TAKE SOME QUESTIONS FROM YOU. FOR PUTTING
UP WITH MY
LONG HOURS AND DEVOTION TO THIS RESEARCH. I THANK YOU VERY MUCH I’M READY TO TAKE QUESTIONS>>THANK YOU SO MUCH FOR YOUR PRESENTATION. YOU CONTRIBUTED SO MUCH TO UNDERSTANDING WOMEN AND HEART DISEASE. MY QUESTION IS, HAVE YOU — DID YOU ASK QUESTIONS ABOUT MENSTRUAL HISTORY AND PREGNANCY IN EARLY STUDIES AND HAD OPPORTUNITY TO LOOK AT THAT AS PERHAPS SECONDARY DATA ANALYSIS? >>YES, WE DID. WE HAD NUMEROUS PAGES OF QUESTIONS ABOUT THIS. WHAT HAPPENED IS WE DIDN’T ANALYZE THIS DATA. I DIDN’T HAVE CONFIDENCE IN IT BECOME TOTALLY ACCURATE. WOMEN THAT HAD PERHAPS HISTECTOMIES OR OOECTOMIES DIDN’T KNOW WHAT THEY HAD DONE AND COULDN’T REMEMBERIS SPECIALLY IF THEY WERE IN THEIR 70S AND 80S. THEY SAID I DIDN’T — I TOOK SOME PILL AND DIDN’T REMEMBER WHAT IT WAS AND HOW LONG THEY HAD TAKEN IT. I WANTED TO REALLY LOOK AT THIS IN-DEPTH AND WE HAD EXCELLENT QUESTIONS ABOUT IT BUT BECAUSE OF NOT HAVING CONFIDENCE IN IT I DIDN’T REPORT IT. I DIDN’T WANT TO MISLEAD ANYONE. WE HAVE THE DATA. THAT WAS A VERY GOOD QUESTION. >>COULD YOU INTRODUCE YOURSELF AS WELL. >>HI, JEAN, SHERYLLY FROM WESTERN UNIVERSITY. I FIND IN MY WORK AND I HAVE GOTTEN WITH WOMEN AND RESPONSES TO CARDIAC EVENTS AND ONE OF THE THINGS I LEARNED IN QUALITATIVE WORK WAS WOMEN’S CAUSAL EXPLANATIONS FOR THEIR SYMPTOMS. WHEN THEY WOULD GO TO THE ER, THEY MIGHT REPORT FATIGUE AND ANXIETY AND QUICK TO GIVE A CAUSAL EXPLANATION. YOU KNOW, MY DAUGHTER’S WEDDING IS COMING UP. CLINICIANS MIGHT NOT TAKE THE SYMPTOM IN THE SAME VAEN GIVEN WOMEN’S CAUSAL EXPLANATIONS WOMEN DON’T DO THAT. GDOC IS THE BIG ONE. >>YES. >>I THINK THAT AS WE — IT IS ON BOTH ENDS BOTH AS HAVING WOMEN PRESENT THEIR SYMPTOMS WITHOUT ALL OF THE THINGS WE DO AND CAUSAL EXPLANATIONS FROM THE VIEWPOINT OF THE WOMEN AND ALSO CLINICIANS TO NOT DISMISS THEIR DIAGNOSTIC INFERENCES BASED ON WOMEN — ON JUST WOMEN’S CAUSAL THINGS. I THINK EARLY DIAGNOSIS IS AN IMPORTANT THING AS YOU KNOW. THAT IS WHAT YOU HAVE BEEN STUDYING. IT IS NOT JUST A SYMPTOM BUT ALSO HOW IT IS PRESENTED BY THE WOMEN OR RECEIVED BY THE CLINICIAN. >>I TOTALLY AGREE. I SPEAK TO LOTS OF WOMEN’S GROUPS AND OBVIOUSLY CLINICIANS. I STRESS THAT VERY MUCH. BIG DIFFERENCE IF WOMAN COMES IN AND SAYS I’M TIRED AND COMES IN AND SAYS I’M SO TIRED I CAN’T EVEN MAKE A BED WITHOUT SITTING DOWN TO REST. I TALK TO BOTH CLINICIANS AND WOMEN ABOUT HOW TO EXPLAIN AND GIVE THEM EXAMPLES HOW THIS SYMPTOM IS IMPACTING THEM. I TOTALLY, TOTALLY AGREE WITH YOU. THAT IS AN EXTREMELY IMPORTANT POINT SHIRLY. YOU HAVE DONE EXCELLENT WORK TOO. OTHER QUESTIONS? >>THANK YOU. THAT IS AN AMAZING TRAJECTORY AND IT IS REALLY INSPIRING, I THINK. I MIGHT TALK I’M FACULTY OF UNIVERSITY OF COLUMBIA IN NURSING. WE TAKE LARGE DATABASES OF CLINICAL TESTS AND SOCIAL MEDIA TEXTS AS WELL AND REMIND THEM FOR NOW I HAVE A COUPLE PROJECTS FOCUSING ON SYMPTOMS THAT IS OF GREAT INTEREST IN PARTICULAR. I, YOU KNOW, IN CLINICIANS REPORTS, I DIDN’T SEE HUGE DIFFERENCES BASED ON GENDER BUT WE ARE STARTING TO LOOK AT IT NOW, RIGHT? HOW SYMPTOMS ARE REPORTED BASED ON GENDER AND OTHER IMPORTANT CHARACTERISTICS. THIS IS FROM MY PERSPECTIVE WHERE I SEE IT THE BEGINNING OF THE RESEARCH KIND OF LOOKING INTO TEXT AND WHAT IS WRITTEN AND SAID ON SOCIAL MEDIA AS WELL. HAVE YOU SEEN ANY OF THIS? DO YOU THINK THERE IS MERIT TO STUDY THIS FURTHER AND TRY TO UNDERSTAND DIFFERENCES FROM DATABASES THAT WE HAVE OUT THERE. >>PROBLEM WITH LARGE DATABASES IS YOU HAVE TO BE CAREFUL FROM EARLY ON IS THAT TO BE INCLUDED IN THOSE STUDIES, HU TO HAVE CHEST PAIN, REPORT OF CHEST PAIN. >>YEAH. >>I HAD WOMEN CAN’T TELL YOU NUMBER OF WOMEN THAT SAID THEY KEPT TRYING TO GIVE ME CHEST PAIN AND I DIDN’T HAVE ANY THEY WOULD GET MAD AT THEM. BE CAREFUL AND LOOK AT INCLUSION CRITERIA CAREFULLY FOR STUDIES IN LARGE DATABASES. >>TAKING CLINICAL DATA NOT JUST STUDIES. >>YES. >>REGULARLY ROUTINE DOCUMENT. THANKS. >>THANK YOU FOR YOUR WORK. >>THANK YOU I’M POLY-JOSEPH. THANK YOU SO MUCH FOR ALL OF THE WORK YOU HAVE DONE. YOU DISCUSSED SYMPTOMS IN WHITES IN AFRICAN-AMERICANS AND SHOW DATA IN HISPANIC’S. HAVE YOU BEEN USING ASIANS ARE SYMPTOMS REPORTING IN OTHER POPULATIONS SIMILAR ACROSS OR YOU SEE DIFFERENCES? >>ASIAN POPULATION YOU MEAN? >>UH-HUH. >>IT IS SUCH A SMALL NUMBER AT THE TIME WE DIDN’T INCLUDE THEM. HE THINK THE STUDY HAS TO BE DONE TO INCLUDE WE HAVE ASIANS PEOPLE OF ASIAN DECENT IN AMERICA. IT WOULD BE IMPORTANT TO DO THAT OCCULTURATED INTO AMERICA FOR GENERATION OR SO BEFORE THEY BEGIN TO DEVELOP CARDIOVASCULAR DISEASE WITH SIGNIFICANT NUMBERS. PART OF WHAT WE RAN INTO WITH HISPANICS CAME INTO COUNTRY THEY WERE YOUNGER AND PROBABLY IN ANOTHER 10 YEARS WE WILL BE ABLE TO PICK UP MORE HISPANIC WOMEN TO PARTICIPATE IN THE STUDIES. I THINK WE NEED TO DO THESE AND CONTINUE TO LOOK AT DIFFERENCES ACROSS ETHNICITIES AND RACES. IT DEFINITELY NEEDS TO BE DONE. >>THANK EVER SGLU THANK YOU FOR THE QUESTION. >>UH-HUH. >>THANK YOU VERY MUCH FOR YOUR LECTURE. THIS IS A TOPIC I’M VERY PASSIONATE ABOUT. MY MOM HAD MI AT 65 LIVING WITH ME HERE. SYMPTOM SHE PRESENTED WAS JAW PAIN. PAINS LIKE CHESTRRHAPHYINESS WAS ALWAYS COMMON WE ASK THE PATIENT I SEE IT WA ENTIN THE LEAST YOU SHOULD. I JUST FINISHED STUDY ON PHD FOR HYPERTENSION AND BORN AFRICAN WOMEN AND SUBGROUP OF POPULATION THAT IS PRESENTED IN RESEARCH. IT WAS INTERESTING THE FINDINGS FROM QUALITATIVE STUDY. I HAD CHALLENGES RECRUITING THEM. I SEE STUDIES MINORITY POPULATION CHALLENGES RECRUITING THEM. CURIOUS TO KNOW WHAT BARRIERS EXPERIENCED AND HOW YOU OVERCAME BARRIERS YOU HAVE TO COME UP WITH THE NUMBERS YOU HAVE AND [INDISCERNIBLE] AFRICAN-AMERICAN UNDER THE BLACK POPULATION THE NUMBER THAT YOU STUDIED IN YOUR RESEARCH. >>SAY THE VERY LAST PART. >>SUBGROUP OF THE BLACK GROUP. >>YES. I DIDN’T DO — ARE YOU TALKING SUBGROUP WITHIN THE BLACK POPULATION. >>YES. >>I DIDN’T DO SUBGROUP WITHIN ANY OF THE PARTICULAR RACES. >>OKAY. >>WE CAN GO BACK AND DO THAT. WE HAVE DATA WE CAN DO THAT. >>OKAY. >>MOST INFORMATION I CAN GIVE YOU WOULD BE WITH CLUSTER ANALYSIS WHICH SHOWED THAT YOUNG AFRICAN-AMERICAN WOMEN HAD MANY MORE SYMPTOMS THAT IS WHERE YOU COULD GO TO THE MANUSCRIPT AND LOOKS AT THAT. THAT WOULD BE YOUR BEST GUIDANCE. RECRUITING AFRICAN-AMERICAN — IF YOU CAN GET TO THE WOMEN, MOST OF THE WOMEN ARE WILLING TO BE IN STUDIES BECAUSE THEY HAD SUCH A DIFFICULT TIME GETTING DIAGNOSED. WE HAD DIFFICULTY PRIMARILY AT ONE OF OUR SITES FOR PREDICT STUDY LAST ONE I DID TO RECRUIT ENOUGH AFRICAN-AMERICAN WOMEN WHEN WE COULD GET INTO CLINIC WE DIDN’T HAVE TROUBLE RECRUITING THEM. IT WAS MORE BEING ABLE TO GET INTO CLINICS. >>OKAY. >>THEY ARE VERY, VERY WILLING TO BE IN THE STUDIES. >>OKAY. >>GOOD LUCK TO YOU WITH YOUR RESEARCH. >>THANK YOU FOR THE NICE PRESENTATION. THIS IS SARA YIN FROM NINR FROM PROGRAM OFFICER AND PORTFOLIO IS WOMEN’S HEALTH. SO I HAVE TWO QUESTIONS. BEFORE MY QUESTION, I DID MY PHD IN AUSTRALIA. MY TOPIC WAS SYMPTOMS AND WARNING SIGNS OF STROKE. AT THE TIME, I DIDN’T REALIZE THAT SYMPTOM SIZE IS THAT IMPORTANT. I DID MOST QUANTITATIVE AND QUALITATIVE RESEARCH. I WAS SO SHOCKED THAT MOST COMMON SYMPTOMS FOR STROKE WAS FLU-LIKE SYMPTOMS I DID QUANTITATIVE AND QUALITATIVE. I DID INFORMATION FROM QUALITATIVE RESEARCH FROM PARTICIPANTS WHO HAD STROKE SECOND COMMON SYMPTOMS WAS FOOD POISONING. I THOUGHT IT WAS VERY INTERESTING FINDINGS. NOW YOU ARE PRESENTING IT. IT IS UP TO SO MANY YEARS. THIS IS SYMPTOM SCIENCE. ANYWAY, MY QUESTION IS THAT I’M WONDERING THAT WHAT IS THE TIME DIFFERENCE BETWEEN YOUR PRODROMAL SYMPTOMS AND ACCURATE SYMPTOMS? HOW MANY DAYS AGO OR HOW DID YOUR DIFFERENCES. >>BETWEEN ACUTE SYMPTOMS AND PRODROMAL? >>YEAH. >>VARIED AMONG WOMEN AND MOST WOMEN COULD REPORT OUT 6 MONTHS OUT MORE FREQUENT AND INTENSE CLOSER TO MI. I HAD ONE REALLY GOOD INFORMANT IN HER LATE 30S. SHE HAD SYMPTOMS A YEAR OUT. SHE HAD I MEAN DOCUMENTATION. SHE DID EVERYTHING RIGHT. SHE WAS STILL MISSED AND HAD ABNORMAL EKG EVEN AND HAD HER MI DRIVING HER CHILDREN HOME FROM SCHOOL. I NEVER FORGOT THAT. MOSTLY, I WOULD SAY ABOUT 6 MONTHS OUT. WOMEN OFTEN TIMES COULDN’T SAY IT WAS THIS DAY THAT I STARTED TO FEEL TIRED. IT TAKES THEM A LITTLE BIT TO REALIZE THAT THEY HAVE UNUSUAL FATIGUE OR OTHER SYMPTOMS. SO IT IS HARD TO GIVE YOU A VERY SPECIFIC TIMEFRAME. I WANTED ONE BUT UNFORTUNATELY, I DIDN’T GET ONE. MOST I WOULD SAY WOULD BE ABOUT 6 MONTHS OUT. >>MY SECOND QUESTION IS DID YOU FIND ANY — I KNOW YOU DIDN’T HAVE MALE, THE MEN AS YOUR REFERENCE GROUP WHEN YOU STUDIED. >>UH-HUH. >>IS THERE ANY WAY TO COMPARE THAT YOU CAN USE MEN AS A REFERENCE GROUP FROM OTHER STUDIES WHETHER THERE ARE DIFFERENCES BETWEEN MEN AND WOMEN WHO HAVE ACUTE SYMPTOMS. MAYBE THERE IS NO INFORMATION FOR PRODROEMAL SYMPTOMS DID YOU FIND ANY DIFFERENCES? >>VERY SMALL STUDY OF MEN. WE HAD LIKE 20 MEN ADMIN IS ITER THIS. THEY ADDED DIFFERENT SYMPTOM DZ FOR PRODROEMAL. PRIMARILY, WE WERE TRYING TO FIND OUT IF THEY WOULD STAY ON A TELEPHONE FOR AN HOUR AND IF WE NEED TO DO IT IN PERSON. WE WERE TRYING TO FIND OUT A WAY TO ACTUALLY ADMINISTER THIS AND NEXT PREDICT STUDY GOT FUNDED I DIDN’T PURSUE THAT ANY FURTHER. MEN DID REPORT SOME PRODROEMAL SYMPTOMS. THAT IS ANOTHER STUDY THAT COULD BE DONE. INVESTIGATOR OVER IN IRAN THAT IS TRANSLATED TO FARSI IS USING IT WITH MEN AND WOMEN. I CAUTIONED HER IT WASN’T DESIGNED FOR MEN AND SHE NEEDED TO HAVE OTHER CATEGORIES OF SYMPTOMS SHE HAD AND I HAVEN’T SEEN THE RESULTS SHE IS STILL DATA COLLECTING WITH THAT. >>THANK YOU VERY MUCH. >>THANK YOU. >>THANK SO YOU MUCH DR. MCSWEENY FOR A WONDERFUL TALK. I’M MARGO FROM THE HEART INSTITUTE IN LA. OUR WOMEN’S HEART CENTER WE TOO FIND ATYPICAL HEART SYMPTOMS I FIND EVERY TIME I GIVE A TALK AND LOOK AROUND AUDIENCE OF MOST WOMEN THAT SAY DO YOU REALIZE THAT THE NO. 1 SYMPTOM IS EXCESSIVE FATIGUE. WHICH ONE OF YOU IS NOT EXCESSIVELY FATIGUES AND TRYING TO QUANTIFY WHAT EXCESSIVE FATIGUE IS HAVE YOU LOOKED INTO THAT AND LEFT ARM PAIN AND SOME WOMEN ACTUALLY FEEL BETTER WITH EXERCISE WHICH IS OFTEN TIMES UNIQUE I THINK TO MIKE VASCULAR DISFUNCTION AND LASTLY YOUR TOOL DO YOU USE IT WITH A CLINICAL SETTING? >>WE ARE TRYING OR DEVELOPING IT RIGHT NOW. WE ARE MODIFYING IT AND WANT TO USE IT IN OBGYN SETTINGS NO. ONE CAUSE OF MATERNAL DEATH RIGHT NOW IS CARDIOVASCULAR DISEASE. >>YES. >>ONE OF MY GOALS TO USE IT IN THE SETTINGS. LOTS OF WOMEN DON’T GET YEARLY CHECKUPS BUT GO TO OBGYN DOCTOR AND LIKELY PLACE TO PICK UP YOUNG WOMEN HAVING PRODROEMAL SYMPTOMS THAT MIGHT NOT BE AWARE OF IT. >>I WOULD LOVE TO TALK TO YOU ABOUT THAT I HAVE A POSTPARTUM HEALTH PROGRAM I FOLLOW POSTPARTUM HYPERTENSION WITH REGISTRY AND BIOREPOSITORY. MAYBE WE CAN TOUCH BASE OFFLINE.>>ABSOLUTELY. >>YEAH. THANK YOU SO MUCH. >>HI. GOOD MORNING. [INDISCERNIBLE] FROM THE INTRAMURAL PROGRAM. THANK YOU VERY MUCH FOR PUTTING ALL THAT TOGETHER FOR US. I HAVE A COMMENT AND A QUESTION. ONE COMMENT IS TO THE POINT ABOUT THE HEART FAILURE MEDICATION. I CAME BACK FROM HEART FAILURE SOCIETY MEETINGS. >>GOOD. >>QUITE THE BUZZ THERE AND GENERATED LOTS OF DISCUSSION BEYOND JUST HEART FAILURE IN TERMS OF DOSING MEDS FOR WOMEN. MORE TO COME ON THAT. >>GOOD NEWS. >>YES. SECONDLY IN TERMS OF PUSH LATELY WITH [INDISCERNIBLE] AND FDA IN TERMS OF INCLUDING ADVOCACY GROUPS AND MORE PATIENTS IN TRIAL PLANNING AND TRIAL RESULT DISSEMINATION HAVE YOU SEEN IT HAPPENING YET WITH WOMEN? DO YOU THINK IT MAY CHANGE SOME OF THE TRAJECTORY IF MORE OF THOSE WOMEN ARE INCLUDING IN TRIAL PLANNING AND TRIAL DESIGN? >>I WOULD HOPE SO. >>YEAH. >>I DON’T HAVE A WAY TO PREDICT IT. I WOULD REALLY HOPE IT WOULD CHANGE. >>YES. >>WOMEN ARE WILLING TO DO IT. THEY WANT TO HELP EACH OTHER VERY MUCH. YOU HAVE BEEN A WONDERFUL AUDIENCE. I THANK YOU AGAIN VERY, VERY MUCH. >>AUDIENCE: [APPLAUSE]. >>SO THANK YOU VERY MUCH FOR OUR FABULOUS PRESENTATION. AS YOU CAN TELL BY THE QUESTIONS, IT IS A VERY IMPORTANT TOPIC THAT MANY PEOPLE ARE ENGAGED IN. THANK YOU SO MUCH FOR COMING AND BRINGING YOUR HUSBAND. YOU DIDN’T EVEN TALK. I THINK YOU WERE ON TV AFTER SOME OF YOUR INITIAL FUNDING. I WAS QUITE IMPRESSED AS IT WAS IN THE 80S OR 90S? WHEN WAS IT? >>2000. >>2000S. TIME GOES BY. 20 YEARS AGO, I WAS SO IMPRESSED AS A NURSE. SHE WAS ON TELEVISION AND TALKING ABOUT — >>SCARY. >>YEAH. TALKING ABOUT HER RESEARCH FINDINGS. SHE HAS ALWAYS BEEN AN INSPIRATION. BEFORE YOU LEAVE, I WANT TO — WE — LET ME JUST SAY THIS. WE WILL POSE. I KNOW SHE IS WANTING ME TO POSE. SO THE NINR RECOGNIZING WITH GRATEFUL APPRECIATION DR. JEAN MCSWEENY FOR NINR DIRECTOR’S
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LECTURE 2019

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