Women’s heart center care improves clinical, psychological outcomes after INOCA, MINOCA
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Most women with myocardial ischemia without obstructive CAD attending a dedicated women’s heart center received new or changed diagnoses and reported decreased chest pain and other improved outcomes at 1 year, researchers reported.
In the first prospective study of 1-year outcomes among Canadian women with ischemia with no obstructive CAD (INOCA) and MI with no obstructive CAD (MINOCA), researchers also found that women attending a dedicated women’s heart center had fewer ED visits and hospitalizations for angina at 1 year compared with the 1 year before their first visit to the women’s heart center.
“Most studies of heart health consist primarily of male participants, and numerous clinical outcomes such as patient symptoms and treatments do not therefore necessarily apply to women with certain types of heart disease,” Tara Sedlak, MD, FRCPC, MBA, cardiologist at Vancouver General Hospital, medical director at Leslie Diamond Women’s Heart Health Clinic and clinical associate professor at University of British Columbia, Canada, said in a press release. “We conducted this research to gain a better understanding of the etiologies and treatment of women with ongoing signs and symptoms of INOCA, which is one of these understudied areas in heart health.”
Assessing women with INOCA, MINOCA
Sedlak and colleagues analyzed data from 154 women, including 112 with INOCA and 42 with MINOCA, with at least once attendance at the women’s heart center at Vancouver General Hospital and 1 year of follow-up by phone, email or in-clinic. Women completed baseline demographics questionnaires; researchers also assessed angina at baseline and 1 year with the Seattle Angina Questionnaire, quality of life with the Quality of Life Enjoyment and Satisfaction Questionnaire and mental health with the Patient Health Questionnaire. The median age of women was 59 years; the most common referral was for chest pain (94% in INOCA and 66% in MINOCA). Researchers compared chest pain frequency, quality of life, depression/anxiety symptoms and CV outcomes at baseline and 1 year.
The findings were published in the Canadian Journal of Cardiology.
At baseline, 64% of patients with INOCA and 43% of patients with MINOCA did not have a specific diagnosis. After investigations in the center, 71.4% of patients with INOCA established a new or a changed diagnosis, including 68% diagnosed with coronary microvascular dysfunction. Among women with MINOCA, 60% established a new diagnosis or a change in diagnosis, including 60% diagnosed with coronary vasospasm.
Evaluation at the women’s heart center also led to therapy modification and improved CV risk factor control at 1 year, including BP, total cholesterol and LDL levels, according to the researchers.
Within 1 year before a first visit to the women’s heart center, 10.7% of participants with INOCA were hospitalized for angina; only 1.8% required hospitalization at 1-year follow-up. Among participants with MINOCA, 50% had hospital admission for angina 1 year before their first women’s heart center visit and 4.8% had ED visits at 1-year follow-up.
At 1 year, participants reported decreased chest pain, improved quality of life and improved mental health compared with before visiting the women’s heart center.
“To our knowledge, this is the first prospective report of the outcomes in Canadian women with chest pain who have attended a women’s heart center,” Sedlak said in the release. “We hope our findings highlight the importance of having a dedicated women-specific heart center, which provides comprehensive care for women with heart disease by providing risk factor assessment, referral to psychiatrists, exercise classes, smoking cessation treatment and consultation with a dietitian in addition to a focus on conditions such as INOCA that are more common in women.”
‘Specific care offers promise’
In a related editorial, Cardiology Today Editorial Board Member C. Noel Bairey Merz, MD, FACC, FAHA, professor of cardiology, director of the Barbra Streisand Women’s Heart Center at the Smidt Heart Institute, Cedars-Sinai, and colleagues wrote that the CVD mortality rate decline in midlife women has stagnated; increasingly recognized INOCA and MINOCA populations provide an opportunity to improve outcomes for women and men using clinical practice, guidelines, clinical trials and research concepts.
“Evidence presented by Parvand et al suggests that specific care offers promise to improve care quality and quality of life outcomes,” Bairey Merz and colleagues wrote. “Diagnostic coding and improved phenotyping of INOCA and MINOCA using noninvasive and invasive strategies provides treatment targets for guideline-directed risk factor and angina management. Ongoing trials are testing the effect on major adverse cardiac events, as well as pathophysiology characterization for novel treatment targets including the autonomic nervous system.”
Reference:
- Dedicated women’s heart canters can improve accurate diagnoses and outcomes. Available at: www.eurekalert.org/news-releases/963486. Published Sept. 7, 2022. Accessed Sept. 7, 2022.
- Pacheco C, et al. Can J Cardiol. 2022;doi:10.1016/j.cjca.2022.06.016.
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