The economic burden of angina in women with suspected ischemic heart disease: results from the National Institutes of Health--National Heart, Lung, and Blood Institute--sponsored Women's Ischemia Syndrome Evaluation.
BACKGROUND
Coronary angiography is one of the most frequently performed procedures in women; however, nonobstructive (ie, < 50% stenosis) coronary artery disease (CAD) is frequently reported. Few data exist regarding the type and intensity of resource consumption in women with chest pain after coronary angiography.


RESULTS
A total of 883 women referred for coronary angiography were prospectively enrolled in the National Institutes of Health--National Heart, Lung, and Blood Institute--sponsored Women's Ischemia Syndrome Evaluation (WISE). Cardiovascular prognosis and cost data were collected. Direct (hospitalizations, office visits, procedures, and drug utilization) and indirect (out-of-pocket, lost productivity, and travel) costs were estimated through 5 years of follow-up. Among 883 women, 62%, 17%, 11%, and 10% had nonobstructive and 1-vessel, 2-vessel, and 3-vessel CAD, respectively. Five-year cardiovascular death or myocardial infarction rates ranged from 4% to 38% for women with nonobstructive to 3-vessel CAD (P < 0.0001). Five-year rates of hospitalization for chest pain occurred in 20% of women with nonobstructive CAD, increasing to 38% to 55% for women with 1-vessel to 3-vessel CAD (P < 0.0001). The volume of repeat catheterizations or angina hospitalizations was 1.8-fold higher in women with nonobstructive versus 1-vessel CAD after 1 year of follow-up (P < 0.0001). Drug treatment was highest for those with nonobstructive or 1-vessel CAD (P < 0.0001). The proportion of costs for anti-ischemic therapy was higher for women with nonobstructive CAD (15% versus 12% for 1-vessel to 3-vessel CAD; P = 0.001). For women with nonobstructive CAD, average lifetime cost estimates were $767,288 (95% CI, $708,480 to $826,097) and ranged from $1,001,493 to $1,051,302 for women with 1-vessel to 3-vessel CAD (P = 0.0003).


CONCLUSIONS
Symptom-driven care is costly even for women with nonobstructive CAD. Our lifetime estimates for costs of cardiovascular care identify a significant subset of women who are unaccounted for within current estimates of the economic burden of coronary heart disease.
Shaw
Leslee J
LJ
Division of Cardiology, Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif, USA. leslee.shaw@emory.edu
Merz
C Noel Bairey
CN
Pepine
Carl J
CJ
Reis
Steven E
SE
Bittner
Vera
V
Kip
Kevin E
KE
Kelsey
Sheryl F
SF
Olson
Marian
M
Johnson
B Delia
BD
Mankad
Sunil
S
Sharaf
Barry L
BL
Rogers
William J
WJ
Pohost
Gerald M
GM
Sopko
George
G
D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000000981:diagnostic imaging / Q000191:economics*; D017023:Coronary Angiography; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000191:economics*; D009316:National Institutes of Health (U.S.); D009765:Obesity / Q000453:epidemiology; D012907:Smoking; D012959:Socioeconomic Factors; D013577:Syndrome; D014481:United States; D014930:Women