Cardiac Rehabilitation for Angina with Non-Obstructive Coronary Arteries: A Scoping Review

Angina with non-obstructive coronary arteries (ANOCA) is associated with impaired quality of life, and cardiac rehabilitation (CR) may be a promising non-pharmacological treatment option. This scoping review aimed to map how cardiac rehabilitation (CR) for patients with ANOCA is described in the literature, including program components, delivery characteristics, reported outcomes, and research gaps.

A scoping review was conducted in accordance with the PRISMA-ScR guidelines. A comprehensive search of seven electronic databases was performed from inception to September 30, 2025. Studies reporting CR interventions in adults with ANOCA or related endotypes were included. Data were charted using the TIDieR checklist and synthesized descriptively. Qualitative findings were organized using a socio-ecological model. Methodological quality was assessed descriptively using the Mixed Methods Appraisal Tool. The database search yielded 14,072 records, of which 26 studies were included. CR interventions were generally safe and well tolerated, with high adherence rates. Patient-reported outcomes consistently improved, particularly angina symptoms, quality of life, and psychological well-being, while effects on physiological outcomes were heterogeneous. Exercise training was the most common intervention component, often individualized and combined with psychosocial therapies. Qualitative findings highlighted unmet needs related to education, psychological support, validation, and flexible, tailored program delivery. Substantial variability and methodological limitations were observed across studies.

CR for patients with ANOCA appears safe, acceptable, and associated with meaningful improvements in patient-reported outcomes; however, evidence remains fragmented. Standardized, patient-centered CR models and long-term research are needed to optimize care and inform clinical practice for this underserved population.