Societal, occupational, and economic considerations for women with (M)INOCA: a narrative review

Area of Science:

• Cardiovascular Medicine
• Occupational Health
• Health Economics

Background:

• Cardiovascular disease is a leading cause of mortality in women, with higher rates of ischemia and myocardial infarction with no obstructive coronary artery disease (INOCA/MINOCA) compared to men.
• Despite underrepresentation in literature, women with (M)INOCA face unique occupational, economic, and psychosocial challenges.
• Existing research often overlooks (M)INOCA, focusing broadly on ischemic heart disease, and lacks recent health economic studies.

Purpose of the Study:

• To review occupational, economic, and psychosocial factors disproportionately impacting women with (M)INOCA.
• To discuss sex-based differences in health care utilization, working status, and job characteristics among patients with nonobstructive coronary syndromes.
• To highlight the need for research on the economic and societal impacts of (M)INOCA and validated tools for measuring work impairment.

Main Methods:

• A narrative review of 50 articles identified through MEDLINE, EMBASE, and CINAHL.
• Keywords included ischemic heart disease, nonobstructive coronary syndromes, (M)INOCA, women's health, questionnaires, surveys, cohort studies, workplace outcomes, and health costs.
• Analysis focused on sex-based differences in health care service utilization, working status, and job characteristics.

Main Results:

• Nonobstructive coronary syndromes are associated with substantial clinical, functional, and economic burdens, despite lower mortality rates.
• Women with (M)INOCA experience significant morbidity, productivity losses, and are more likely to exit the workforce early.
• There is a lack of recent health economic studies and validated tools to measure work impairment in this population.

Conclusions:

• Women with (M)INOCA face considerable morbidity and economic consequences, including significant work productivity losses.
• Addressing the interplay of sex-based differences and societal impacts is essential for improving outcomes for women with (M)INOCA.
• Collaborative efforts involving workplaces and employers are needed to tackle work-related outcomes and develop targeted interventions.