(P001) ADVERSE MEDICATION REACTIONS IN WOMEN WITH NON-OBSTRUCTIVE CORONARY SYNDROMES: IMPACT ON SYMPTOM MANAGEMENT AND QUALITY OF LIFE

Background: Non-obstructive coronary artery syndromes include myocardial infarction (MI) and ischemia with no obstructive coronary artery disease (MINOCA, INOCA), and account for up to 10% of MI and 30% of stable angina in women. There is a paucity of research on effective medical therapy for (M)INOCA, and consequently little data on adverse medication reactions in this population and how these impact symptom management and quality of life.

METHODS AND RESULTS: This study investigated 163 female patients enrolled in the Leslie Diamond Women’s Heart Health Clinic Registry (WHC) in Vancouver, BC, with diagnosed (M)INOCA. Cardiologist consultation notes were analyzed to determine whether patients reported any adverse reactions (AR) to medications during the study period, the culprit medication, the reported symptoms, and the treatment of the reaction. The Seattle Angina Questionnaire (SAQ) was administered at 3 years after the initial WHC visit and significance between groups assessed using the Student’s t-test. Differences in the frequencies of demographic, clinical, and female-specific variables were investigated between groups with or without AR, with Chi-squared tests used for significance testing.

During the first 3 years following initial WHC visit, 108 (69%) patients experienced an adverse reaction (AR) to at least one medication. Adverse reactions to medications included headache, light-headedness, dizziness, constipation, diarrhea, fatigue, depression, rash, edema, tachy/bradycardia, cough, and/or myalgias, and none of these reactions were classed as serious adverse events. While 27% of reactions were treated by lowering the dose and 17% by switching to a medication of the same or similar class, in most cases these approaches were not successful, and the medication was stopped altogether (32%) (Table 1). Additional medications to manage reaction symptoms were added in 5%, while 7% of reactions spontaneously resolved. When comparing SAQ scores between AR groups (Table 2), at 3 years, patients who experienced an AR had lower scores by over 10 points in both the Physical Limitation (p < 0.001) and Angina Frequency (p < 0.001) subdomains, while Quality of Life and Medication Satisfaction subdomains were not significantly different. ARs occurred significantly more frequently in those with thyroid disease (84%) than in those without (62%, p=0.04), and in those with Raynaud’s phenomenon (94%) than in those without (63%, p=0.03).

Conclusion: Adverse reactions to medications in (M)INOCA patients are common and are associated with worsened self-reported physical limitations and angina frequency symptoms. Clinical trials and further observational studies of potential new therapies are urgently needed in this under-studied population.