Mental health, health status, and recurrent healthcare utilization in patients with non-obstructive coronary artery disease

Background

Recurrent cardiac healthcare utilization (HCU) is common in patients with non-obstructive coronary artery disease (NOCAD), yet the long-term psychosocial and health-status determinants of care use remain insufficiently understood. Identifying these factors is essential for improving patient-centered management and reducing unnecessary diagnostic testing.

Methods

In this 10-year prospective cohort study, 546 patients (52% women) with angiographically or CT-confirmed NOCAD were followed for emergency department (ED) visits for cardiac symptoms and repeat diagnostic cardiac tests. Baseline assessments included measures of mental health (anxiety, depressive symptoms, Type D personality) and health status (fatigue, generic and disease-specific quality of life). Negative binomial regression models examined associations between baseline psychosocial factors and total HCU, adjusting sequentially for age, sex, education, obesity, diabetes, and major adverse cardiovascular events (MACE). Sex-stratified and MACE-stratified exploratory analyses were performed.

Results

Half of the cohort experienced at least one cardiac-related healthcare contact during follow-up. In age- and sex-adjusted models, higher baseline anxiety and fatigue, poorer physical health, greater angina frequency, and lower quality of life were associated with higher HCU. After full adjustment, lower baseline quality of life, diabetes, and subsequent MACE remained independent predictors of greater HCU. Sex-stratified analyses showed that more frequent angina and lower quality of life predicted HCU in women but not in men. Most patients with recurrent HCU did not develop MACE, indicating that persistent subjective symptom burden, rather than objective disease progression, drove long-term utilization.

Conclusions

In patients with NOCAD, recurrent cardiac HCU is common and is independently predicted by baseline quality of life and cardiometabolic risk. Sex-specific psychosocial patterns contribute to care use, particularly among women. These findings highlight the need to integrate psychosocial assessment, symptom evaluation, and quality-of-life monitoring into routine care to optimize management and reduce recurrent healthcare utilization.

What Is Known

• Recurrent cardiac healthcare utilization (HCU) is common in patients with non-obstructive coronary artery disease (NOCAD), even when objective disease progression is absent.

• Symptom burden and psychosocial distress have been suggested as important drivers of healthcare-seeking behavior in this population.

What the Study Adds

• Lower baseline quality of life independently predicts higher long-term HCU over a 10-year period.

• Sex-specific patterns emerged, with angina frequency and poorer quality of life predicting recurrent HCU in women only.

• Most recurrent care occurred without subsequent major adverse cardiovascular events, underscoring that subjective symptom burden—rather than disease progression—drives long-term utilization.