Abstract 14748: Unheard Voices: The Burden of Ischemia and No Obstructive Coronary Artery Disease in Women

Introduction: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality in women. Up to two-thirds of women with IHD suffer from ischemia with no obstructive CAD (INOCA), which includes endotypes such as microvascular dysfunction and vasospasm. Due to a lack of clear prognostic data, INOCA has historically been viewed as a benign condition, and many women have been dismissed from cardiovascular care despite refractory symptoms and a risk for adverse outcomes.

Hypothesis: Women with INOCA have a high burden of symptoms and significant functional limitation due to poorly controlled symptoms, which can be characterized with a structured interview.

Methods: We enrolled 41 women with INOCA who underwent clinically-indicated invasive coronary physiology testing. Structured interviews were performed to elicit symptom characteristics, limitations, and perception of illness. Data extracted from the interviews was analyzed using the constant comparison method to determine common themes among women with INOCA.

Results: The most common symptoms in our sample included chest pain (n=38, 93%), dyspnea (35, 85%), fatigue (32, 78%), and abnormal heart rhythms (27, 66%). Most patients experienced symptoms daily (24, 59%) and reported that their symptoms were severe (33, 80%). They expressed limitations to instrumental activities of daily living (25, 61%), hobbies (23, 56%), work (19, 46%), and travel (11, 27%). Many reported a sense of foreshortened future (26, 63%), a feeling of invalidation by providers and loved ones (25, 61%), and difficulty getting a diagnosis (31, 76%). After receiving a diagnosis, they reported positive outcomes such as reduced stress and better understanding of disease management (38, 93%).

Conclusions: Women with INOCA have significant impairment in quality of life due to frequent anginal symptoms. Feelings of invalidation were common, and many patients reported multiple incorrect diagnoses. After receiving a diagnosis, they reported reduced stress, improvement in illness perception, and hope for improved health in the future. These findings demonstrate the importance of recognizing INOCA and incorporating advances such as physiology-guided medical therapy into routine practice.