Short summary

This project contributes important knowledge in health and recovery among women living with angina and no diagnosis of obstructive coronary artery disease (CAD). Despite great advances within cardiology during the last decades, the knowledge of women living with angina pectoris and no confirmed obstructive coronary artery disease (CAD) is limited. Thus, in this project, we want to describe the patient population, their characteristics, and health status for three years of follow-up.

Rationale

With a prevalence of more than 200,000 patients, ischemic heart disease is the most common cause of chronic heart diseases in Denmark. Similarly, worldwide, ischemic heart disease is the leading cause of death. Among women, angina pectoris is the most prevalent symptom of ischemic heart disease typically caused by obstructive CAD (≥50% luminal diameter stenosis in ≥1 epicardial coronary artery).

In the field of cardiology, more than half of women experiencing angina pectoris demonstrate no signs of obstructive CAD, which is twice as frequently as men. Treatment of angina is guided by the presence of obstructive CAD, which leaves women with angina and no confirmed obstructive CAD underdiagnosed and with inaccuracies in the use of diagnostic terms. The consequences of living with angina without obstructive CAD are multifactorial and as most earlier studies have presented a mean age of women with non-obstructive CAD being from 48.5-57 years many of these women are younger and still at a working age. Younger women, being far from retirement and required to provide for their families might have different challenges returning to everyday life, including returning to work following non-obstructive CAD. However, no emphasis has been given to investigating patterns of women's employment status before and after the first hospitalization. Moreover, several studies indicate that the persistent symptom burden often leads to uncertainty and diminished quality of life, multiple hospital readmission, and re-assessments for obstructive CAD and it is implicated that the population is costly to health care.

Similarly, studies have demonstrated how women, in general, continue to have symptoms and are at increased risk of cardiovascular morbidity and mortality compared to men. In addition, the Danish recommendations on cross-sectoral programs for people with cardiac disease and rehabilitation do not include these women in existing follow-up modalities. Combined, this leaves these women in a particularly vulnerable situation.

Finally, a clinical definition of the population is required to gain more knowledge of the extent to which these women are readmitted, in contact with the general practitioner, out-of-hour services, or emergency room visits. This knowledge might help clinicians to shape the future clinical pathway and follow-up after the first admission of angina pectoris.

Thus, the overall aim of this study is to generate in-depth knowledge on women's health status and the clinical pathway within the years after the first coronary angiogram or coronary computed tomography angiography performed due to suspected angina pectoris symptoms based on several sub-studies. This knowledge is needed to identify future women at risk of poor outcomes and to develop clinical interventions and possible follow-up modalities after discharge.

The study will be divided into four sub-studies; Study 1 will be conducted based on data of women discharged with symptoms of angina and no diagnosis of CAD, derived from data from the DenHeart study, a national cohort study including a survey based on validated patient-reported outcomes measured at discharge and combined with register-based clinical- and sociodemographic variables and follow-up (Study 1 is not under OPEN).

Study 2 will be designed as a validation study based on data from national registries and medical journals, and studies 3 and 4 will be conducted as register-based cohort studies based on national registries. The population will include women with angina, and no obstructive CAD admitted from 2009-2021.

Description of the cohort

Adult women discharged from the hospital with a diagnosis related to angina and no confirmed obstructive coronary artery disease investigated with coronary angiogram or coronary computed tomography angiography.

Data and biological material

Study 2 is based on data from national medical journals whereas study 3 and 4 is based on data from the national registers (The National Patient Register, The Health Insurance Register, The Danish Civil Registration Register, The Danish Education Register, The DREAM Database, and The Drug Database). Clinical information will be drawn from The Danish Heart Registry.

Collaborating researchers and departments

Department of Cardiology, University Hospital of Odense

• Lektor, Ph.d. Britt Borregaard
• Professor Lisette Okkels Jensen