Clinical standards in angina and non-obstructive coronary arteries: A clinician and patient consensus statement

Patients with angina and non-obstructive coronary arteries (ANOCA) or myocardial ischaemia with nonobstructive coronary arteries (INOCA) comprise a relatively large subgroup within those with ischaemic heart disease. Advances in the understanding of disease mechanisms, diagnostic tests and multidisciplinary care are improving awareness of the needs of affected individuals. However, practice variations and suboptimal management promulgate the health burden and increase health care resource consumption. Clinical standards represent a limited number of quality statements that describe the care patients should be offered by health professionals and providers for a specific clinical condition or defined clinical pathway in line with current best evidence. Clinical standards should address implementation of this evidence along with education of patients and healthcare professionals, multidisciplinary care networks, and research. In this consensus statement, we highlight contemporary evidence and stakeholder views, including clinicians and patients, to provide an international perspective for developing clinical standards for services involving ANOCA/INOCA patients. A clinical service for ANOCA/INOCA should "consider the whole patient" and provide a multidisciplinary, patient-centred service.