Biopsychosoc Sci Med. 2026 Oct 1;88(8):703-712. doi: 10.1097/PSY.0000000000001519. Epub 2026 Aug 11.
ABSTRACT
OBJECTIVE: Recurrent cardiac health care utilization (HCU) is common in patients with nonobstructive coronary artery disease (NOCAD), yet long-term mental health, personality, and health status contributing to repeated emergency department visits (ED) and diagnostic testing remain unclear. This study examined 10-year patterns and predictors of recurrent cardiac HCU in patients with NOCAD.
METHODS: In total 546 patients (52% women) were followed with ED visits or repeat diagnostic tests. Baseline assessments included anxiety, depressive symptoms, type D personality, fatigue, health status, and disease-specific quality of life. Negative binomial regression evaluated associations between baseline mental health and health status and total HCU, with adjustment for age, sex, education, obesity, diabetes, and major adverse cardiac events (MACE). Sex-stratified and MACE-stratified analyses were explored.
RESULTS: During follow-up, 24% of the patients experienced a single, and 26% multiple HCU. Higher anxiety, fatigue, poorer physical health, more frequent angina, and lower quality of life were associated with greater HCU, in age and sex-adjusted models. After full adjustment, lower baseline quality of life, diabetes, and subsequent MACE remained independent predictors. Sex-stratified analyses showed that baseline angina frequency and lower quality of life predicted HCU in women. Most patients with recurrent HCU did not develop MACE, suggesting that subjective symptom burden, rather than disease progression, was the main driver of long-term HCU.
CONCLUSIONS: Recurrent HCU is frequent in NOCAD and is strongly influenced by baseline quality of life and cardiometabolic risk. These findings highlight the need to address symptom burden in NOCAD to reduce recurrent testing and improve long-term outcomes.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT01788241) https://clinicaltrials.gov/study/NCT01788241.
PMID:42814520 | DOI:10.1097/PSY.0000000000001519