Symptom experience of women with ischemia and no obstructive coronary artery disease: A mixed-methods approach

Background Women with myocardial ischemia with no obstructive arteries (INOCA) often have coronary microvascular dysfunction (CMD) or coronary vasospasm. INOCA is associated with adverse cardiovascular event risk, recurrent angina hospitalizations, and reduced health-related quality of life (QoL). Objectives In this mixed-methods study we used qualitative data to understand angina burden, while considering overall symptom experience of patients living with INOCA. Methods Twenty-four women with INOCA confirmed by coronary angiography were enrolled. A majority ( n = 20) had coronary function testing to diagnose CMD or vasospasm. In addition to demographics and risk factors, angina and QoL were evaluated using the Seattle Angina Questionnaire (SAQ) (scored 0–100, higher score being better), along with Duke Activity Score Index and PHQ-8. Qualitative telephone interviews were conducted, recorded, transcribed, and analyzed for themes to explore patients' experiences. Descriptive statistics were performed for quantitative data. 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 63 % having hypertension, 75 % hyperlipidemia, and 25 % diabetes. SAQ scores indicated high angina frequency (50.5 ± 21.2), low angina stability (35.2 ± 31.5), physical limitations (37.7 ± 24.3), and poor QoL (41.3 ± 23.2). Qualitative analysis identified four major themes: Invisible inscrutable threat , Longing for a normal/safe life , Rejecting labels , and “ It has a toll ”. All patients expressed both diagnosis related emotional burden and explicit frustration. Conclusions This study highlights the substantial emotional and physical challenges women living with INOCA experience, emphasizing critical care gaps. Research efforts should prioritize understanding pathophysiologic mechanisms and improving symptom management to better support patient QoL.