Temporal trends and factors associated with emergency department visits and hospitalizations in angina with no obstructive coronary artery disease (ANOCA)

Introduction Angina with no obstructive coronary artery disease (ANOCA) presents diagnostic and treatment challenges, significantly burdening healthcare resources as reported in previous studies. This study assessed temporal changes in emergency department (ED) visits and hospitalizations for ANOCA and factors associated with these outcomes. Methods/Results We assessed a retrospective cohort of 85,573 individuals (26% with ANOCA, 31% female, mean age 62.1±12.0 years) who underwent their first cardiac catheterization for chest pain in Alberta from 2002 to 2017. Temporal trend analysis showed ED visits ranged from 26.3% to 30.7% (β=0.21 [95%CI:-0.28 to 0.70];p=0.33) for ANOCA and from 47.7% to 53.1% (β=-0.15[95%CI:-0.87 to 0.57];p=0.63) for obstructive CAD, with no temporal changes in either. Hospitalizations decreased from 6.5% to 3.8% (β=-0.28 [95%CI:-0.47 to -0.09];p=0.010) for ANOCA and from 24.8% to 15.3% (β=-1.45 [95%CI:-1.77 to -1.12];p<0.001) for obstructive CAD. Multivariable logistic regression analysis factors associated with ED visits in individuals with ANOCA included cerebrovascular disease (CEVD) (OR=1.73 [95%CI:1.40–2.15]), congestive heart failure (CHF) (OR=1.91 [95%CI:1.49–2.44]), peripheral artery disease (PAD) (OR=1.61 [95%CI:1.18–2.19), and unstable angina (UA) (versus (vs) stable angina (SA): OR=1.65 [95%CI:1.51–1.80]). Factors associated with hospitalizations in ANOCA included CEVD (OR=1.39 [95%CI:1.11–1.73]), CHF (OR=2.06 [95%CI:1.66–2.56]), hypertension (OR: 1.26 [95%CI:1.14–1.40]), PAD (OR=1.89 [95%CI:1.43–2.50]), and myocardial infarction (vs SA: OR=1.27 [95%CI:1.12–1.44]), and UA (vs SA: OR=1.36 [95%CI:1.22–1.52]). Conclusions ED visits for ANOCA remained stable, while hospitalizations declined over time. Understanding factors associated with recurrent visits may aid clinicians in treatment strategies. Clinical Perspective What is new? This study was the first to characterize emergency department (ED) visits and assess temporal trends of ED visits and hospitalizations in individuals with ANOCA. ED visits for individuals with ANOCA or obstructive CAD have remained stable over time, with a significant decline in hospitalizations for both groups. In contrast to previous studies, individuals with obstructive CAD had higher ED visits and hospitalizations rates than those with ANOCA. What are the clinical implications? Increased recognition of ANOCA may be responsible for decreasing hospitalizations. Despite increased awareness, individuals with ANOCA still frequently visit the ED, highlighting the need for improved education on persistent chest pain and unnecessary ED visits. The development of specialized chest pain clinics using a multidisciplinary approach could reduce unnecessary ED visits and hospitalizations, thereby improving the quality of life for individuals with ANOCA.