Your Heart Speaks Survey Programme – the characteristics associated with an early versus late diagnosis in ANOCA patients

Background Angina with non-obstructive coronary arteries (ANOCA) is increasingly recognised, yet the factors influencing whether patients receive an early versus delayed diagnosis remain unclear. Identifying these features may help reduce diagnostic delays and improve patient outcomes. Purpose To examine chest pain characteristics that may contribute to a diagnostic delay in a global ANOCA cohort. Methods In partnership with the International Heart Spasms Alliance, an ongoing web-based survey program was launched to collect global patient perspectives. Participants were recruited internationally via social media and cardiology networks, with surveys capturing demographics, diagnoses and chest pain characteristics. Results Of the 851 participants, most were female (89%), Caucasian (91%), and resided in Europe (42%), North America (40%) or Australia/Oceania (16%). A total of 52% were diagnosed within 12 months of symptom onset (early diagnosis), whereas 48% were diagnosed over 12 months from symptom onset (late diagnosis). Compared to those with an early diagnosis, those with a late diagnosis were younger when their chest pain symptoms commenced (51 ± 11.4 vs 44 ± 12.7, p<0.05). However, despite the delay in diagnosis, they had more classical anginal symptoms including ‘chest tightness/heaviness’ (90% vs 96%, p<0.05) with radiation to the left arm (33% vs 39%, p<0.05) or jaw (26% vs 35%, p<0.05), precipitated by effort (52% vs 68%, p <0.05) or exposure to cold (40% vs 54%, p<0.05), and more likely to be nitrate-responsive (66% vs 75%, p<0.05). Conclusion The delay in the diagnosis of ANOCA is not attributable to chest pain symptoms, since these patients have more classical angina symptoms than those diagnosed earlier. However, their pain-onset is at a younger age, which may bias the clinical assessment and lead to a delayed diagnosis.