Emergency department visits among non-Western and Western women with no obstructive coronary artery disease: results from a nationwide cohort

BACKGROUND: More than half of women experiencing angina pectoris or non-specific chest pain are diagnosed with non-obstructive coronary artery disease (CAD), with a higher proportion being non-Western. The study aimed to describe emergency department (ED) visits among non-Western and Western women with chest pain but no obstructive CAD and to investigate the association between ethnicity and ED visits within 3 years following the diagnosis. METHODS: A substudy to the Danish nationwide register-based WOMen with symptoms of Angina or non-specific chest pain but NO obstructive CAD (WOMANOCA) cohort with non-Western and Western women. The women were divided into two groups: symptoms of angina or non-specific chest pain. All women underwent diagnostic assessment with either coronary angiography or cardiac CT. The association between ethnicity and ED visits was investigated using multivariable Cox proportional hazard models adjusted for age, Charlson Comorbidity Index, body mass index and educational level. Results were reported as HRs with 95% CIs. RESULTS: In total, 60 666 women were included in the two groups (angina n=17 835, non-specific chest pain n=42 831) with 8% and 9% being non-Western in the angina group and the non-specific chest pain group, respectively (n=1484 and n=3644). In both symptom groups, non-Western women more commonly presented to the ED following diagnosis compared with Western women (angina, adjusted HR 1.42, 95% CI 1.28 to 1.56, non-specific, adjusted HR 1.25, 95% CI 1.18 to 1.33). CONCLUSIONS: Ethnicity was associated with ED visits, with non-Western women having significantly more visits regardless of whether the underlying chest pain was related to angina or non-specific symptoms.