There is unmet need of sex focused registries to be the first step towards sex focused trials and guidelines. In Iraq due to absent electronic database and research funding, it is challenging to initiate long term cardiovascular registries. For studies involving women patients in Middle East, in general and Iraq; in particular, it is challenging to contact the female patients by male doctors due to cultural and custom barriers. IROCW aims to portrait the demographics focusing on sex-specific risk factors, presentation, in-hospital and 1-month outcomes of women admitted to cardiac centers or cardiology wards in general hospitals. Patients with any of the following diagnoses were included in the registry: IHD (ACS admitted to CCU or chronic coronary syndromes admitted for elective catheterization), arrhythmia, heart failure and valvular heart disease.

Under the Umbrella of Iraqi Scientific Council of Cardiology, a female interventional cardiologist was among the leaders of the study, so, she enhanced the recruitment of female trainees besides male doctors to participate in data collection and patients follow up to bridge the cultural barriers. IROCW is a prospective, multicentre, cross-sectional study.  Patients with any of the following diagnoses were included in the registry: IHD (ACS admitted to CCU or chronic coronary syndromes admitted for elective catheterization), arrhythmia, heart failure and valvular heart disease. Data collection using paper forms was done by investigators then data entry started and stopped after seven weeks to assess feasibility and reliability of data entry into google form that was designed for the registry. If the registry is feasible using paper forms and google form, then the next phase will be international and assessing 12-month cardiovascular outcomes (target number=10,000 patients; total number in all four arms of registry).

 n=150, mean age=60 years, 89.3% of patients reside in urban areas. Women were mostly married (67.8%) or widowed (25.5%). They were illiterate (47.3%) or having primary education (34.7%). 60% of women's family total income<500 USD. Most common risk factor was hypertension while menopause and gestational hypertension were most common sex-specific risk factors. In-hospital echocardiography was done in 26%. In-hospital heart failure was reported in 20% of patients. Aspirin, P2Y12 inhibitors, heparin, and statin were used in: 85.8%, 60.4%, 35.4% and 87.9% respectively. B-blockers, ACEI/ARBs and MRA were used in 71.1%, 62.8%, and 7.2% respectively.  Dietary instructions as indicated on discharge was done properly in 96.6%, while smoking cessation counseling and referral for cardiac rehabilitation were not done properly. At 1-month follow up, patients were reachable in 91.5%.

Illiteracy and poor socio-economic status in women raise the importance of dedicated approach required for health education and care. Despite absent electronic data base and lack of research funding in Iraq, this study is feasible. The next international phase (Iraq and Sudan) will be initiated, so, data from LMIC from both Asia and Africa will be available to bridge knowledge gaps in CVD in women from these countries.