Jane Lange Dalsgaard

Background: More than half of women experiencing angina pectoris or non-specific chest pain are diagnosed with non-obstructive coronary artery disease (CAD), with a higher proportion being non-Western. The study aimed to describe emergency department (ED) visits among non-Western and Western women with chest pain but no obstructive CAD and to investigate the association between ethnicity and ED visits within 3 years following the diagnosis. Methods: A substudy to the Danish nationwide register-based WOMen with symptoms of Angina or non-specific chest pain but NO obstructive CAD (WOMANOCA) cohort with non-Western and Western women. The women were divided into two groups: symptoms of angina or non-specific chest pain. All women underwent diagnostic assessment with either coronary angiography or cardiac CT. The association between ethnicity and ED visits was investigated using multivariable Cox proportional hazard models adjusted for age, Charlson Comorbidity Index, body mass index and educational level. Results were reported as HRs with 95% CIs. Results: In total, 60 666 women were included in the two groups (angina n=17 835, non-specific chest pain n=42 831) with 8% and 9% being non-Western in the angina group and the non-specific chest pain group, respectively (n=1484 and n=3644). In both symptom groups, non-Western women more commonly presented to the ED following diagnosis compared with Western women (angina, adjusted HR 1.42, 95% CI 1.28 to 1.56, non-specific, adjusted HR 1.25, 95% CI 1.18 to 1.33). Conclusions: Ethnicity was associated with ED visits, with non-Western women having significantly more visits regardless of whether the underlying chest pain was related to angina or non-specific symptoms.

Aims: Women with suspected angina but no obstructive coronary artery disease (CAD) may be at risk of frequent healthcare contacts due to persistent symptoms, but evidence is scarce. The study aimed to investigate healthcare use following a first diagnosis of angina or non-specific chest pain among a nationwide population of women with no obstructive CAD, compared to a reference population. Methods and results: The WOMANOCA cohort (Women with symptoms of angina or non-specific chest pain but no obstructive CAD) included all Danish women with a first diagnosis of angina or non-specific chest pain from 2009 to 2019 (following in registries for 3 years) and matched to asymptomatic reference women by age. Cox regression models assessed healthcare contacts between groups, reported as hazard ratios (HR) with 95% confidence intervals (CI). In total, 17 836 women were diagnosed with angina and 42 832 with non-specific chest pain, matched to 303 247 references. Women with angina and women with non-specific chest pain had a higher risk of all cardiac readmissions compared to the references (HR 3.24 95% CI 3.10–3.38 and HR 2.87 95% CI 2.78–2.97, respectively), with an increased association for angina compared to non-specific chest pain (HR 1.16 95% CI 1.10–1.22). Being a woman with non-specific chest pain was significantly associated with GP direct consultations, out-of-hours consultations, and ECGs compared to angina and the reference women. Conclusion: Despite no obstructive CAD, the WOMANOCA cohort had an increased use of new healthcare contacts, indicating a sustained healthcare burden among women with any type of chest pain.

Aims: Women who have survived spontaneous coronary artery dissection (SCAD) struggle to resume their lives as before SCAD and lack knowledge on how to recover. Thus, this study aimed to explore the rehabilitation needs and challenges in resuming everyday life among women with SCAD. Methods and results: A qualitative approach using a phenomenological–hermeneutical methodology. We conducted six virtual focus groups involving 26 women with SCAD, recruited from a patient group. The focus groups were video-recorded, transcribed, and analysed using Ricoeur's theory of interpretation. The findings led to three themes: (i) Distrust of the normally well-functioning body, (ii) Being the expert on your condition, and (iii) Rehabilitation following SCAD: A matter of both the heart and the mind. The women strive to regain trust in their bodies and minds while reinforcing the distinction between the physical and mental self before and SCAD. The women felt a responsibility to educate themselves about SCAD, as professionals' lack of knowledge or misconceptions often left them managing their condition on their own. The one-sided focus on physical rehabilitation neglected the psychological impact, leaving women without strategies for managing the new everyday life with SCAD. Conclusion: The study highlights the complex physical and psychological rehabilitation needs and challenges faced by women following SCAD due to profound alterations in their lives, distrust in their bodies and the burden of becoming experts on their condition. Tailored rehabilitation programs that address these needs, in addition to improving healthcare professionals’ knowledge about SCAD, are essential for enhancing recovery and quality of life.

The objectives were to describe differences in self-reported health at discharge between women diagnosed with angina or unspecific chest pain and investigate the association between self-reported health and adverse outcomes within 3 years. Data from a national cohort study were used, including data from the DenHeart survey combined with 3 years of register-based follow-up. The population included two groups of women with symptoms of angina but no diagnosis of obstructive coronary artery disease at discharge (women with angina and women with unspecific chest pain). Self-reported health measured with validated instruments was combined with register-based follow-up on adverse outcomes (a composite of unplanned cardiac readmissions, revascularization, or all-cause mortality). Associations between self-reported health and time to first adverse outcomes were investigated with Cox proportional hazard models, reported as hazards ratios with 95% confidence intervals. In total, 1770 women completed the questionnaire (49%). Women with angina (n = 931) reported significantly worse self-reported health on several outcomes compared to women with unspecific chest pain (n = 839). Within the 3 years follow-up, women with angina were more often readmitted (29 vs. 23%, P = 0.011) and more underwent revascularization (10 vs. 1%, P < 0.001), whereas mortality rates were similar (4 vs. 4%, P = 0.750). Self-reported health (physical and mental) was associated with adverse outcomes between both groups (on most instruments). Women with angina reported significantly worse self-reported health on most instruments compared to women with unspecific chest pain. Adverse outcomes varied between groups, with women diagnosed with angina experiencing more events. ClinicalTrials.gov (NCT01926145).