Advancing Health Work in Progress Seminar: Does a dedicated women’s heart center improve clinical outcomes?

Tara Sedlak, MD, FRCPC, MBA
Scientist, Advancing Health
Clinical Associate Professor, Division of Cardiology, Department of Medicine, UBC
Cardiologist, Vancouver General and BC Women’s Hospitals
Director, Leslie Diamond Women’s Heart Health Clinic, VGH

Does a dedicated women’s heart center improve clinical outcomes?

Background: Myocardial infarction with no obstructive coronary arteries (MINOCA) and ischemia with no obstructive coronary arteries (INOCA), are female predominant conditions, with a lack of clinical trials guiding medical management for the common underlying vasomotor etiologies. Long-term outcomes of (M)INOCA patients following attendance at a women’s heart center (WHC) are lacking.

Methods: Women diagnosed with MINOCA (n=51) or INOCA (n=112) were prospectively followed for 3 years at the Vancouver WHC. Baseline characteristics, diagnoses, chest pain type, major adverse cardiac events, hospital encounters, medications, and Seattle Angina Questionnaire (SAQ) responses were compared between baseline and 3 years. Chi-squared tests were used to compare categorical variables, with students’ t-tests for continuous variables.

Results: MINOCA patients had significantly more non-exertional chest pain and diagnoses of vasospasm than INOCA patients, who had more exertional chest pain and diagnoses of coronary microvascular dysfunction. Following baseline, both groups had significant reductions in cardiovascular emergency room visits, with INOCA patients also experiencing fewer cardiovascular hospitalizations. At 3 years, the most commonly prescribed medications were calcium channel blockers, long-acting nitrates and beta blockers, with MINOCA having more acetylsalicylic acid and INOCA more short-acting nitrates and ranolazine prescriptions. Both groups observed significant improvements in SAQ scores, with greater improvements observed in INOCA patients. Patients with depression at baseline or prescribed ranolazine at 3 years had worse SAQ scores at baseline.

Conclusions: Three-year outcomes of (M)INOCA patients indicate that the WHC’s comprehensive care model effectively improves diagnostic clarity, reduces hospital encounters, optimizes medication management, and improves self-reported patient well-being.