Breaking organ silos: first nationwide implementation of an interdisciplinary network targeting INOCA and coronary microvascular dysfunction in women
M E Wittekoek, D K E Van Dijken, D L van de Graaf, T Juurlink, J J S KooijAbstract
Background
Ischemia with no obstructive coronary arteries (INOCA) is a major contributor to cardiovascular morbidity in women and is closely linked to coronary microvascular dysfunction (CMD) 1-2. Beyond microvascular disease alone, INOCA reflects a broader neurovascular–hormonal interaction that challenges traditional organ-based cardiology and requires integrated interdisciplinary care. Autonomic stress activation, inflammatory signalling and hormonal transitions modulate coronary microvascular function, contributing to delayed recognition and fragmented care. Despite growing scientific awareness, structured interdisciplinary cardiovascular care models remain scarce.
Methods
The H3 (Head–Heart–Hormones) network was developed as one of the first nationwide interdisciplinary implementation initiatives integrating cardiology, psychiatry, gynecology and primary care. Supported by a national program, regional networks were established across 12 Dutch provinces through structured interdisciplinary meetings, shared educational frameworks and defined collaboration pathways to improve recognition and integrated management of CMD and related neurovascular conditions. Participants completed standardized evaluations assessing baseline collaboration, barriers, learning outcomes and implementation readiness.
Results
A total of 204 healthcare professionals participated. Baseline interdisciplinary collaboration was limited: 68.1% reported no structural collaboration and only 3.9% reported established integrated pathways. Initial cardiology participation was low (2.5%), reflecting fragmentation within traditional coronary care pathways for women with suspected INOCA. Key barriers included time constraints (66.7%), difficulty identifying collaborators (53.9%) and lack of coordination (46.6%). After implementation, 84.8% reported sufficient knowledge to continue working within the H3 framework. Overall satisfaction reached 93.7%, and 94.2% would recommend participation. Participants reported increased awareness of CMD and improved readiness to deliver integrated management.
Conclusion
This first nationwide interdisciplinary implementation targeting CMD and neurovascular–hormonal modifiers of cardiovascular disease in women demonstrates feasibility, strong professional engagement and high perceived clinical relevance. The H3 model addresses critical gaps in traditional cardiology pathways and provides a scalable framework to advance integrated recognition and management of INOCA within sex-specific cardiovascular medicine.
Future Directions
Ongoing evaluation will assess patient-level outcomes, diagnostic timelines and the impact of interdisciplinary pathways on clinical management of CMD.