Title : Enhancing MINOCA care: A single-centre retrospective cohort study and Quality improvement initiative at Frimley Health NHS Foundation Trust
Abstract:
Background: Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) is a diagnostic challenge, leading to inconsistent care and patient uncertainty. This Quality Improvement (QI) initiative aimed to establish a baseline of MINOCA management to justify and design a standardised diagnostic pathway within a UK NHS trust.
Methods: A retrospective cohort analysis was conducted at Frimley Park and Wexham Park Hospitals (July-December 2023). Patients with a working diagnosis of MINOCA or Angina with Non-Obstructive Coronary Arteries (ANOCA) were identified. Data on diagnostic investigations, including Cardiac Magnetic Resonance (CMR) completion rates, and final diagnoses were collected from electronic patient records.
Results: From 976 screened patients, 132 (13.5%) had MINOCA and 185 had ANOCA. The MINOCA cohort was 58% female. A definitive diagnosis was achieved in only 70% (93/132) of cases; 39 (30%) remained undiagnosed. Myocarditis (n=17) and Takotsubo cardiomyopathy (n=15) were the most common aetiologies. Of 59 planned CMRs, 50 (85%) were completed, and this investigation was pivotal in securing a diagnosis.
Conclusion: Baseline data revealed a high prevalence of MINOCA and a significant rate of diagnostic failure, underscoring an urgent need for a standardised pathway. These findings directly informed the development of a new, guideline-based diagnostic algorithm to improve diagnostic yield, guide appropriate therapy, and optimise resource utilisation within the NHS.
Keywords: MINOCA, ANOCA, Quality Improvement, Diagnostic Pathway, Cardiac MRI, NHS.
