The use of healthcare contacts following a first diagnosis of chest pain among women with no obstructive coronary artery disease: results from the WOMANOCA nationwide cohort study

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.