The long and winding road to diagnosis: diagnostic delays and healthcare utilization in patients with CFT-confirmed INOCA
4 affiliations
- 1Department of Internal Medicine, NYU Grossman School of Medicine
- 2Graduate Medical Education, NYU Grossman School of Medicine
- 3Center for Women’s Cardiovascular Health, Leon H. Charney Division of Cardiology, NYU Langone Health
- 4Section of Cardiology, Department of Medicine, VA NY Harbor Health Care System
Abstract
Background: Patients with Ischemia and No Obstructive Coronary Arteries (INOCA) experience recurrent angina, report reduced quality of life, and are at increased risk for major adverse cardiovascular events. Unfortunately, INOCA is often unrecognized and can be difficult to diagnose.
Methods: We included patients with angina and INOCA diagnosed by invasive coronary function testing (CFT) and characterized their interactions with the healthcare system. Data on initial symptom onset, frequency and type of healthcare encounters, specialty referrals, diagnostic testing (including non-invasive and invasive cardiac testing, pulmonary, GI, and musculoskeletal evaluation), and medication trials for angina were abstracted from the electronic medical record.
Results: We included 91 patients with INOCA who underwent CFT for determination of endotype (36% with coronary microvascular dysfunction, 35% with vasomotor disorders, 29% mixed endotype). The median time from first anginal symptom to diagnosis was 3.2 years (IQR 0.8–7.3 years), with 450 presentations to the healthcare system for angina prior to CFT. Among healthcare presentations, 72% occurred in an outpatient setting and 28% occurred in the emergency department. Each patient had a median of 3 clinic visits and 1 ED visit. A total of 225 referrals to 6 different specialties occurred, with 18% of patients seen by ≥3 cardiologists prior to diagnosis. There were 441 diagnostic tests performed for angina [median 4 (IQR 3–7) per patient], 14% of which were non-cardiac studies [median 0 (IQR 0–1) per patient]. Patients trialed a median of 2 (1–3) medications prior to diagnosis.
Conclusion: Many patients with INOCA experience prolonged diagnostic journeys, marked by repeated healthcare encounters, multiple specialists’ visits, high testing burden, and multiple trials of medication. These findings underscore the need for earlier consideration of INOCA in the assessment of angina and more efficient diagnostic strategies.
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BibTeX
@article{wang2026long,
title = {{The long and winding road to diagnosis: diagnostic delays and healthcare utilization in patients with CFT-confirmed INOCA}},
author = {Angela Wang and Rose Huang and Yvonne Shea and Harmony R. Reynolds and Nathaniel R. Smilowitz and Anaïs Hausvater},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1924728},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1924728/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The long and winding road to diagnosis: diagnostic delays and healthcare utilization in patients with CFT-confirmed INOCA
AU - Angela Wang
AU - Rose Huang
AU - Yvonne Shea
AU - Harmony R. Reynolds
AU - Nathaniel R. Smilowitz
AU - Anaïs Hausvater
PY - 2026
DA - 2026/10/07
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1924728
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1924728/full
AB - Background: Patients with Ischemia and No Obstructive Coronary Arteries (INOCA) experience recurrent angina, report reduced quality of life, and are at increased risk for major adverse cardiovascular events. Unfortunately, INOCA is often unrecognized and can be difficult to diagnose. Methods: We included patients with angina and INOCA diagnosed by invasive coronary function testing (CFT) and characterized their interactions with the healthcare system. Data on initial symptom onset, frequency and type of healthcare encounters, specialty referrals, diagnostic testing (including non-invasive and invasive cardiac testing, pulmonary, GI, and musculoskeletal evaluation), and medication trials for angina were abstracted from the electronic medical record. Results: We included 91 patients with INOCA who underwent CFT for determination of endotype (36% with coronary microvascular dysfunction, 35% with vasomotor disorders, 29% mixed endotype). The median time from first anginal symptom to diagnosis was 3.2 years (IQR 0.8–7.3 years), with 450 presentations to the healthcare system for angina prior to CFT. Among healthcare presentations, 72% occurred in an outpatient setting and 28% occurred in the emergency department. Each patient had a median of 3 clinic visits and 1 ED visit. A total of 225 referrals to 6 different specialties occurred, with 18% of patients seen by ≥3 cardiologists prior to diagnosis. There were 441 diagnostic tests performed for angina [median 4 (IQR 3–7) per patient], 14% of which were non-cardiac studies [median 0 (IQR 0–1) per patient]. Patients trialed a median of 2 (1–3) medications prior to diagnosis. Conclusion: Many patients with INOCA experience prolonged diagnostic journeys, marked by repeated healthcare encounters, multiple specialists’ visits, high testing burden, and multiple trials of medication. These findings underscore the need for earlier consideration of INOCA in the assessment of angina and more efficient diagnostic strategies.
SN - 2297-055X
ER -