Living with angina: rethinking angina management in ANOCA through lived experience.

Angina with non-obstructive coronary arteries (ANOCA) is an important cause of chronic angina and reduced quality of life. Despite advances in diagnostic testing and growing recognition of coronary vasomotor disorders, many of those living with ANOCA continue to experience ongoing symptoms despite treatment. The existing literature largely focuses on diagnostic methods and pharmacological management, while comparatively little attention has been paid to the lived experience of symptom control. The objective of this perspective paper, produced with the co-founders of the International Heart Spasms Alliance, is to explore angina management in ANOCA through the lens of lived experience and patient advocacy. Key challenges include the substantial impact of chronic angina on daily life, difficulties identifying effective therapies, the need to adapt to a new normal, reliance on self-management strategies, uncertainty surrounding acute symptom escalation, and the importance of support and validation. Improved angina management in ANOCA requires a holistic and individualised approach that combines mechanism-based treatment, multidisciplinary support, and meaningful incorporation of lived perspectives into clinical care and research. Successful angina management should be measured not only by symptom reduction, but also by improvements in quality of life and overall wellbeing.