Letter to the Editor by Nazli Parast and colleagues to OJIN topic: “Healthcare and Quality: Perspectives from Nursing”

March 1, 2023

Response by Nazli Parast and colleagues to OJIN topic: “Healthcare and Quality: Perspectives from Nursing” (September 30, 2013).

Dear Editor,

We are writing in response to the OJIN topic, “Healthcare and Quality: Perspectives from Nursing.” We are suggesting it’s time to look at myocardial infarction with non-obstructive coronary artery from a nursing perspective. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a myocardial infarction with normal or near-normal coronary arteries on angiography (Sucato et al., 2021). In patients with MINOCA there is less than 50% obstruction in the coronary arteries (Pacheco et al., 2021). It is important to note that it was previously believed that patients who were diagnosed with MINOCA had a great prognosis, but now it is estimated at least 3.5% of patients with MINOCA have a 1-year all-cause mortality rate (Ekenbäck et al., 2022). It is important to note that a number of patients were previously misdiagnosed with MINOCA due to physician’s lack of realization of the condition (Tamis‐Holland & Jneid, 2018). As the awareness regarding MINOCA is increasing among physicians, the number of patients accurately diagnosed with MINOCA will increase. Therefore, the patients’ demand from nurses for specific education will increase. Addressing this issue by developing a patient education guide is a first step that requires timely attention.

As more patients are being accurately diagnosed with this specific condition, similar to any other diagnosed patient population, patients and their caregivers expect resources and information regarding their medical condition. Patient and their caregivers require knowledge regarding management strategies to enhance their health outcomes (Thompson et al., 2021). Recently we discovered the need for a MINOCA patient education guide when patients diagnosed with this condition requested the specific guide from the nurses. We completed a literature review to establish if there are any existing comprehensive educational resources to guide patients and caregivers through their journey while dealing with their diagnosis of MINOCA. None of the articles provided an actual handout or booklet for patient or caregiver education regarding MINOCA; however, they provided great insight to initiate a path to develop educational resources.

A study revealed that secondary preventive measures are associated with better prognosis in patients with MINOCA and these patients need similar follow-up as patients with obstructive coronary artery disease (Eggers et al., 2018). Patient and caregiver education is needed to enable self-advocacy, prevention, and follow-up among patients with MINOCA. Today, patients are knowledge-seekers and can obtain inaccurate information from the internet (DeMarco et al., 2011). Patient education material that is comprehensive and can provide up-to-date and accurate information to patients, can serve as a resource to support patients and their families to refer to better cope with their condition. As noted by DeMarco et al. (2011) patient education is viewed as part of the “continuum of health care” and providing proper health information is the foundational element to having a positive impact on the patients. At the University of Ottawa Heart Institute, we received feedback from patient partners who described being diagnosed with MINOCA as complex and overwhelming and revealed learning challenges experienced about their condition throughout their journey to diagnosis and after. With the help from a multidisciplinary working group, we developed a guide that is currently under internal review with the goal of addressing the existing knowledge gap from the patient perspective.


Nazli Parast, RN, CDE, BScN, MScN, EdD(c), naparast@ottawaheart.ca
Amy Charlebois, RN, BScN, MScN
Samantha Theriault, RN, BScN
Bonnie Quinlan, RN, BScN, MScN
University of Ottawa Heart Institute


DeMarco, J., Nystrom, M., & Salvatore, K. (2011). The importance of patient education throughout the continuum of health care. Journal of Consumer Health on the Internet, 15(1), 22-31. https://doi.org/10.1080/15398285.2011.547069

Ekenbäck, C., Tornvall, P., & Agewall, S. (2022, June 6). MINOCA from A to Z. Latest in Cardiology. https://www.acc.org/latest-in-cardiology/articles/2022/01/05/17/41/minoca-from-a-to-z

Eggers, K. M., Hadziosmanovic, N., Baron, T., Hambraeus, K., Jernberg, T., Nordenskjöld, A., Tornvall, P., & Lindahl, B. (2018). Myocardial infarction with nonobstructive coronary arteries: The importance of achieving secondary prevention targets. American Journal of Medicine, 131(5), 524-531.e6. https://doi.org/10.1016/j.amjmed.2017.12.008

Pacheco, C., Mullen, K. A., Coutinho, T., Jaffer, S., Parry, M., Van Spall, H. G., Clavell, M. A., Edwards, J. D., Sedlak, T., Norris, C. M., Dhuki, A., Grewal, J., & Mulvagh, S. L. (2021). The Canadian Women’s Heart Health Alliance atlas on the epidemiology, diagnosis, and management of cardiovascular disease in women--Chapter 5: Sex-and gender-unique manifestations of cardiovascular disease. CJC Open, 4(2), 243-262. https://doi.org/10.1016/j.cjco.2021.11.006

Sucato, V., Testa, G., Puglisi, S., Evola, S., Galassi, A. R., & Novo, G. (2021). Myocardial infarction with non-obstructive coronary arteries (MINOCA): Intracoronary imaging-based diagnosis and management. Journal of Cardiology, 77(5), 444-451. https://doi.org/10.1016/j.jjcc.2021.01.001

Tamis‐Holland, J. E., & Jneid, H. (2018). Myocardial infarction with nonobstructive coronary arteries (MINOCA): It's time to face reality! Journal of the American Heart Association, 7(13), e009635. https://doi.org/10.1161/JAHA.118.009635

Thompson, D. L., May, E. J., Leach, M., Smith, C. P., & Fereday, J. (2021). The invisible nature of learning: Patient education in nursing. Collegian, 28(3), 341-345. https://doi.org/10.1016/j.colegn.2020.08.002