Michael Skov Hansen

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.

Background: Long-term rhythm monitoring (LTRM) can detect undiagnosed atrial fibrillation (AF) in patients at risk of AF and stroke. Circulating microRNAs (miRNAs), which have been shown to play a role in atrial electrical and structural remodelling, could help to select patients who would benefit most from LTRM. The aim of this study was to investigate whether patients with diabetes mellitus (DM) and hypertension and screen-detected subclinical AF (SCAF) using an insertable cardiac monitor (ICM) have significantly different plasma baseline levels of five selected miRNAs playing a role in the modulation of atrial electrical and structural remodelling (miR-21-5p, miR-29b-3p, miR-150-5p, miR-328-3p, and miR-432-5p) compared to those without SCAF. Methods: This study was performed at the outpatient clinic of a secondary academic teaching hospital between December 2013 and November 2015. Eligible patients were ≥65 years of age with DM and hypertension but without known heart diseases. All patients received an ICM. On the day of ICM implantation, blood samples for the measurement of plasma levels of the five miRNAs were drawn. In this post hoc analysis, we investigated their expression by reverse transcription-quantitative polymerase chain reaction. MiRNA plasma levels in patients with and without newly detected SCAF were compared. Results: We included 82 consecutive patients (median age of 71.3 years (IQR 67.4–75.1)), who were followed for a median of 588 days (IQR: 453–712 days). Seventeen patients (20.7%) had ICM-detected SCAF. Plasma levels of miR-328-3p, miR-29b-3p, miR-21-5p, miR-432-5p, and miR-150-5p were slightly but not significantly different in patients with incident SCAF compared with patients without. Conclusions: In patients with hypertension and DM, newly detected SCAF was not significantly associated with changes in expression levels of miR-21-5p, miR-29b-3p, miR-150-5p, miR-328-3p, and miR-432-5p.

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).