Abstract 11143: Symptom Experience in Women With Ischemia and No Obstructive Coronary Artery Disease: A Mixed Methods Approach

Abstract

Introduction: Women with myocardial ischemia but no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction, a condition associated with adverse cardiovascular outcomes. INOCA patients have recurrent chest pain and reduced quality of life, but therapeutic strategies to treat INOCA are poorly defined. In this study we used mixed methods to gain an understanding of their symptom patterns and burden clustered with other co-morbid conditions, while considering their overall symptom experience with having chronic angina. Methods: Twenty-four women diagnosed with INOCA based on coronary angiography were enrolled. Qualitative telephone interviews were conducted, recorded, and transcribed verbatim. First and second cycle coding was then used to analyze the qualitative data. Baseline demographics, risk factors, and angina burden by the Seattle Angina Questionnaire (SAQ) were assessed and descriptive statistics were performed. Results: Mean age was 53.2±10.8 years and body mass index was 30.8±6.9 kg/m 2 . Cardiac risk factors were prevalent with 43% hypertension, 57% hyperlipidemia, and 22% diabetes. SAQ scores indicated high angina burden and poor quality of life: 37.7±24.3 (physical limitation), 35.2±31.5 (angina stability), 41.3±23.2 (quality of life). Elemental qualitative coding and analysis identified four major themes: Invisible inscrutable threat, Longing for a normal/safe life, Rejecting labels, and “It has a toll”. A majority (75%) expressed both emotional burden and explicit frustration and dissatisfaction around their diagnosis. Conclusion: Qualitative and quantitative data supported that despite high symptom burden and poor quality of life, patients felt that they were frequently not believed, and that knowledge was limited to manage their condition. Research to close this persistent knowledge gap and to prioritize symptom management to help INOCA patients regain as much normalcy as possible is needed.