(CCSP110) SPECIALIZED WOMEN'S HEART CLINIC IMPROVES QUALITY OF LIFE AND REDUCES HOSPITAL ENCOUNTERS IN PATIENTS WITH NON-OBSTRUCTIVE CORONARY SYNDROMES

Background: Myocardial infarction (MI) with no obstructive coronary arteries (MINOCA) or ischemia with no obstructive coronary arteries (INOCA) are more common in women than men and have been shown to carry worse major adverse cardiac outcomes for women. However, longitudinal studies of outcomes in women with (M)INOCA are lacking. Further, the impact on quality of life, incidence of hospital encounters, and other long-term outcomes after attending specialized women’s heart clinics (WHC) have not been well-studied in Canada.

METHODS AND RESULTS: This study investigated 3-year outcomes in female patients with (M)INOCA enrolled in the Leslie Diamond Women’s Heart Health Clinic Registry since 2016 in Vancouver, Canada. Baseline Seattle Angina Questionnaire (SAQ), Patient Health Questionnaire (PHQ-9) and Quality of Life Enjoyment and Satisfaction Questionnaire (QLESQ) were compared to 3 years following enrolment. Emergency room (ER) visits and hospitalizations related to cardiovascular symptoms were quantified through review of provincial electronic medical records 3 years prior to and following initial WHC consultation. In MINOCA patients, the index hospitalization for MI was excluded. Paired Wilcoxon rank sum tests compared medians between timepoints for each survey. Fisher’s test compared frequencies of hospital encounters. Patient scores at 3 years were compared to baseline and categorized as “improved”, “no change” or “worsened” based on the minimal clinically important difference (MCID) for each survey: SAQ >±10 points per domain, PHQ-9 >±5 points, and QLESQ >±9 points.

133 women with (M)INOCA were included (n=40 MINOCA, n=93 INOCA). The mean age for MINOCA was 57 years (s.d. 11.3) and INOCA 59 years (s.d. 10.8). For patients with INOCA, significant improvements were observed across all SAQ domains, PHQ-9 and QLESQ scores, with significantly fewer cardiovascular hospitalizations and ER visits at 3 years compared to 3 years pre-baseline. For patients with MINOCA, only the SAQ quality of life domain improved, with significantly fewer cardiovascular ER visits. Irrespective of timepoint, MINOCA patients had better SAQ scores than INOCA patients. Improvements above the MCID were noted in the (M)INOCA patients for SAQ quality of life and in INOCA patients for SAQ angina frequency. The majority of patients did not demonstrate improvements above the MCID for PHQ-9 and QLESQ.

Conclusion: Attendance at a multidisciplinary WHC significantly improves angina control, quality of life and mental health with fewer healthcare encounters at 3 years in women with (M)INOCA. Further studies are warranted to evaluate associations between risk factors and pharmacological management with these outcomes.