Table 3 - uploaded by Tina Pittman Wagers
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Source publication
Purpose:
Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic type of acute myocardial infarction that primarily affects young, healthy women without typical risk factors for heart disease. Few investigations have examined psychosocial variables in this population and none have looked at patient perceptions of the experience and s...
Contexts in source publication
Context 1
... contrast, only 9% of participants identified information provided by "doctors and/or other health care professionals" as most helpful. Table 3 displays the referrals participants received post- SCAD, as well as average helpfulness ratings: 72% of sur- vey participants were referred to CR, and the 2 highest helpfulness ratings were attributed to CR and "exercise programs other than CR," which participants described as customized exercise programs. The average helpfulness rat- ing for these customized exercise programs was similar to that reported for CR (7.00 vs 6.84). ...
Context 2
... reported strong interest overall in participat- ing in a SCAD-specific patient psychosocial education or support group with a notable preference for online patient groups with a professional leader. Far fewer participants reported interest in an online or in-person peer-facilitated group (see Table 3). ...
Citations
... Predominantly affecting younger women without atherosclerosis and with few traditional cardiac risk factors [3][4][5], SCAD comes as a shock and is not suited to traditional lifestyle management approaches [6,7]. Emotional stress is often reported as a precipitator to SCAD events [4,6,[8][9][10][11]. ...
... Several studies undertaken in the US, Canada, Australia, and Europe have documented relatively high rates of anxiety and depression in the aftermath of SCAD [11][12][13][14][15][16][17]. Emerging evidence suggests that SCAD-AMI may be more stressful than typical atherosclerotic AMI, with higher rates of post-event anxiety and depression [13,17]. ...
... Again the rate was higher than after non-SCAD cardiac events [32]. Previous studies have demonstrated that SCAD survivors commonly receive inadequate or insufficient information regarding safe exercise levels [11,18,33,34], explaining the confusion and uncertainty around this issue. Recent evidence shows that SCAD survivors want tailored physical activity advice to suit individual needs, capabilities and preferences [33]. ...
Introduction
Recent studies suggest that acute myocardial infarction due to spontaneous coronary artery dissection (SCAD) carries significant psychosocial burden. This survey-based quantitative study builds on our earlier qualitative investigation of the psychosocial impacts of SCAD in Australian SCAD survivors. The study aimed to document the prevalence and predictors of a broad range of psychosocial and lifestyle impacts of SCAD.
Method
Australian SCAD survivors currently enrolled in the Victor Chang Cardiac Research Institute genetics study were invited to participate in an online survey to assess the psychosocial impacts of SCAD. Participants completed a questionnaire, developed using findings from our earlier qualitative research, which assessed 48 psychosocial and five lifestyle impacts of SCAD. Participants also provided demographic and medical data and completed validated measures of anxiety and depression.
Results
Of 433 SCAD survivors invited to participate, 310 (72%) completed the questionnaire. The most common psychosocial impacts were ‘shock about having a heart attack’ (experienced by 87% respondents), ‘worry about having another SCAD’ (81%), ‘concern about triggering another SCAD’ (77%), ‘uncertainty about exercise and physical activity’ (73%) and ‘confusion about safe levels of activity and exertion’ (73.0%) and ‘being overly aware of bodily sensations’ (73%). In terms of lifestyle impacts, the SCAD had impacted on work capacity for almost two thirds of participants, while one in ten had sought financial assistance. The key predictors of psychosocial impacts were being under 50, current financial strain, and trade-level education. The key predictors of lifestyle impacts were being over 50, SCAD recurrence, trade-level education, and current financial strain. All psychosocial impacts and some lifestyle impacts were associated with increased risk of anxiety and/or depression.
Conclusion and implications
This quantitative study extends our previous qualitative investigation by documenting the prevalence of each of 48 psychosocial and five lifestyle impacts identified in our earlier focus group research, and by providing risk factors for greater SCAD impacts. The findings suggest the need for supports to address initial experiences of shock, as well as fears and uncertainties regarding the future, including SCAD recurrence and exercise resumption. Support could be targeted to those with identified risk factors. Strategies to enable SCAD survivors to remain in or return to the paid workforce are also indicated.
... 22 Another study asked patients about their experiences with post-SCAD psychosocial support. 23 Participants reported that informational support was inadequate and that cardiac rehabilitation, general counseling, and stress management were moderately helpful. This study, however, recruited patients liberally using social media and included only female participants. ...
Background
Clinical practice guidelines for the management and convalescence of patients with spontaneous coronary artery dissection (SCAD) have yet to be developed. The targeted content, delivery, and outcomes of interventions that benefit this population remain unclear. Patient‐informed data are required to substantiate observational research and provide evidence to inform and standardize clinical activities.
Methods and Results
Patients diagnosed with SCAD (N=89; 86.5% women; mean age, 53.2 years) were purposively selected from 5 large tertiary care hospitals. Patients completed sociodemographic and medical questionnaires and participated in an interview using a patient‐piloted semistructured interview guide. Interviews were transcribed and subjected to framework analysis using inductive and then deductive coding techniques. Approximately 1500 standard transcribed pages of interview data were collected. Emotional distress was the most commonly cited precipitating factor (56%), with an emphasis on anxiety symptoms. The awareness and detection of SCAD as a cardiac event was low among patients (35%) and perceived to be moderate among health care providers (55%). Health care providers' communication of the prognosis and self‐management of SCAD were perceived to be poor (79%). Postevent psychological disorders among patients were evident (30%), and 73% feared recurrence. Short‐ and longer‐term follow‐up that was tailored to patients' needs was desired (72%). Secondary prevention programming was recommended, but there were low completion rates of conventional cardiac rehabilitation (48%), and current programming was deemed inadequate.
Conclusions
This early‐stage, pretrial research has important implications for the acute and long‐term management of patients with SCAD. Additional work is required to validate the hypotheses generated from this patient‐oriented research.
... Only 3/53 studies provided information on cardiac rehabilitation, with the method of reporting varied. While one provided the rate of referral to cardiac rehabilitation, 14 the other two reported on the proportion of patients who attended cardiac rehabilitation. 13 15 LIMITATIONS This systematic review is limited by the under reporting of several quality-of-care measures, particularly cardiac rehabilitation and FMD screening. ...
Aim
The first expert consensus documents on management of patients with spontaneous coronary artery dissection (SCAD) were published in 2018. Worldwide quality of care, as measured by adherence to these recommendations, has not been systematically reviewed. We aim to review the proportion of patients with SCAD receiving consensus recommendations globally, regionally and, determine differences in practice before and after 2018.
Methods and results
A systematic review was performed by searching four main databases (Medline, Embase, SCOPUS, CINAHL) from their inception to 16 June 2022. Studies were selected if they included patients with SCAD and reported at least one of the consensus document recommendations. 53 studies, n=8456 patients (mean 50.1 years, 90.6% female) were included. On random effects meta-analysis, 92.1% (95% CI 89.3 to 94.8) received at least one antiplatelet, 78.0% (CI 73.5 to 82.4) received beta-blockers, 58.7% (CI 52.3 to 65.1) received ACE inhibitors or aldosterone receptor blockers (ACEIs/ARBs), 54.4% (CI 45.4 to 63.5) were screened for fibromuscular dysplasia (FMD), and 70.2% (CI 60.8 to 79.5) were referred to cardiac rehabilitation. Except for cardiac rehabilitation referral and use of ACEIs/ARBs, there was significant heterogeneity in all other quality-of-care parameters, across geographical regions. No significant difference was observed in adherence to recommendations in studies published before and after 2018, except for lower cardiac rehabilitation referrals after 2018 (test of heterogeneity, p=0.012).
Conclusion
There are significant variations globally in the management of patients with SCAD, particularly in FMD screening. Raising awareness about consensus recommendations and further prospective evidence about their effect on outcomes may help improve the quality of care for these patients.
... Immediate complications of SCAD include ventricular tachyarrhythmias, ventricular free wall or septal rupture, congestive heart failure, and cardiogenic shock [3,8,10,13,14,15,19]. As a common symptom following spontaneous coronary artery dissection is chest pain, which can occur as a sequela of the dissection or due to non-cardiac causes such as stress, anxiety, or depression the patients should be evaluated for possible psychiatric disorders, such as post-traumatic stress disorder, depression, and anxiety, to improve their quality of life [9,10,14,18]. ...
A rare and sporadic disease, Spontaneous Coronary Artery Dissection (SCAD) consists of obstruction of the coronary artery by intramural hematoma, with or without rupture of the intimal layer, without association with atherosclerosis, trauma or iatrogenesis. It is an important cause of acute coronary syndrome (ACS) and sudden death in individuals without typical cardiovascular risk factors. It predominates in women between the 4th and 5th decades of life, being the most common cause of ACS associated with pregnancy, in patients with underlying arteriopathies, especially fibromuscular dysplasia; in individuals with systemic inflammatory diseases such as systemic lupus erythematosus, sarcoidosis, or inflammatory bowel disease; or with hereditary arteriopathies, such as Ehlers-Danlos vascular syndrome and Marfan syndrome. Surviving patients present as clinical manifestations of ACS, ventricular arrhythmias, cardiogenic shock or sudden cardiac arrest, with chest pain consistent with atherosclerotic ACS and elevated cardiac enzymes. The accurate diagnosis of SCAD is important, as its management differs from that of atherosclerotic ACS. If suspicion, coronary angiography should be performed, classifying the lesion according to the Saw Angiographic Classification: if multiple radiolucent lumens or contrast coloration of the arterial wall, type 1; if diffuse stenosis >20 mm, type 2, being the most common; if focal or tubular stenosis <20 mm that mimics atherosclerotic lesion, type 3. American College of Cardiology (ACC)/ American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines suggests conservative treatment in clinically stable patients, and an early invasive strategy by angioplasty coronary artery in patients with severe lesions. Coronary artery bypass surgery is considered in high-risk injuries.
... 7,8 The internet is more commonly rated as the most helpful information source, than are doctors or other healthcare professionals. 9 This lack of awareness of SCAD in clinicians is likely to contribute to mental distress following SCAD 7,9 and may impair the quality-of-care received. A 2020 survey reported that up to a third of patients with SCAD were not diagnosed at the time of their myocardial infarction (MI). ...
... 7,8 The internet is more commonly rated as the most helpful information source, than are doctors or other healthcare professionals. 9 This lack of awareness of SCAD in clinicians is likely to contribute to mental distress following SCAD 7,9 and may impair the quality-of-care received. A 2020 survey reported that up to a third of patients with SCAD were not diagnosed at the time of their myocardial infarction (MI). ...
... • Perceived quality-of-care of SCAD was highly associated with quality-of-life. of stress, anxiety, and other mental health challenges during the first year after SCAD. 9,[16][17][18] Indeed, there is evidence that rates of anxiety, depression, and distress may be higher in SCAD survivors than in those with typical atherosclerotic MI. 10,[19][20][21] It is unclear if SCAD is a risk factor for the development of mental health issues, or if mental health issues are risk factors for SCAD, particularly given that stress is commonly cited as a precipitating trigger for SCAD. 5,[22][23][24][25] No studies have yet investigated the relationship between SCAD onset, the quality-of-care received, and mental health status. ...
Aims
Spontaneous coronary artery dissection (SCAD) is an under-recognized cause of myocardial infarction. We aimed to investigate SCAD survivors’ perceptions of their quality-of-care and its relationship to quality-of-life.
Methods and results
An anonymous survey was distributed online to SCAD survivors involved in Australian SCAD support groups, with 172 (95.3% female, mean age 52.6 ± 9.2 years) participants in the study. The survey involved assessment of quality-of-life using a standardized questionnaire (EQ-5DTM-3L). Respondents rated the quality-of-care received during their hospital admission for SCAD with a median of 8/10 [interquartile range (IQR) 7–10]. Respondents ≤ 50 years vs. >50 years were more likely to perceive that their symptoms were not treated seriously as a myocardial infarction (χ2 = 4.127, df = 1, P < 0.05). Participants rated clinician’s knowledge of SCAD with a median of 4/10 (IQR 2–8) and 7/10 (IQR 3–9) for Emergency and Cardiology clinicians, respectively (P < 0.05). The internet was the most selected source (45.4%) of useful SCAD information. The mean EQ-5DTM summary index was 0.79 (population norm 0.87). A total of 47.2% of respondents reported a mental health condition diagnosis, with 36% of these diagnosed after their admission with SCAD. Quality-of-life was significantly associated with perceived quality-of-care: EQ-5DTM index/(1-EQ-5DTM index) increased by 13% for each unit increase in quality-of-care after adjusting for age and comorbidities (P < 0.001).
Conclusion
While SCAD survivors rated their overall hospital care highly, healthcare providers’ knowledge of SCAD was perceived to be poor, and the most common source of SCAD information was the internet. Mental health conditions were common, and a significant association was observed between perceived quality-of-care and SCAD survivors’ quality-of-life.
... It is a non-traumatic and non-iatrogenic spontaneous separation o coronary artery wall [10,14,15]. Coronary artery dissection is more commonly observ women [16]. A recent study has found that nearly 32% of participants reported enga in very intense or unusual physical exertion in the two weeks before the occurren coronary artery dissection [16]. ...
... Coronary artery dissection is more commonly observ women [16]. A recent study has found that nearly 32% of participants reported enga in very intense or unusual physical exertion in the two weeks before the occurren coronary artery dissection [16]. Coronary artery dissection may not be visible on coro angiography [14]. ...
... It is a non-traumatic and non-iatrogenic spontaneous separation of the coronary artery wall [10,14,15]. Coronary artery dissection is more commonly observed in women [16]. A recent study has found that nearly 32% of participants reported engaging in very intense or unusual physical exertion in the two weeks before the occurrence of coronary artery dissection [16]. ...
Myocardial infarction (MI) in young athletes is very rare but can have serious consequences, including sudden cardiac death (SCD), an increased proarrhythmic burden in future life, and/or heart failure. We present two cases of young athletes with MI. They did not have previous symptoms, traditional risk factors, or a family history of MI. One case involves a 37-year-old male amateur athlete who experienced two MI following intense physical exertion, likely due to the erosion of an insignificant atherosclerotic plaque caused by a sudden increase in blood pressure during exercise. The second case describes a 36-year-old male semi-professional runner who collapsed at the finish line of a half-marathon and was diagnosed with hypertrophic cardiomyopathy. The heart's oxygen demand-supply mismatch during intensive exercise led to MI. Following the case presentation, we discuss the most common causes of MI in young athletes and their mechanisms, including spontaneous coronary artery dissection, chest trauma, abnormalities of the coronary arteries, coronary artery spasm, plaque erosion, hypercoagulability, left ventricular hypertrophy, and anabolic steroids use.
... 11-15 Indeed, emotional stress is often reported as the precipitating trigger for the acute SCAD event. 3,6,9,11,[16][17][18] Uncertainty and lack of information provision surrounding the diagnosis and optimal management, and the likelihood of recurrence, contribute to the psychosocial sequelae of SCAD. 11,19 Emerging evidence therefore suggests that SCAD may be more stressful than typical AMI. ...
... 3,6,9,11,[16][17][18] Uncertainty and lack of information provision surrounding the diagnosis and optimal management, and the likelihood of recurrence, contribute to the psychosocial sequelae of SCAD. 11,19 Emerging evidence therefore suggests that SCAD may be more stressful than typical AMI. ...
... 35 This finding underscores how the current lack of knowledge about and understanding of SCAD among health professionals is central to SCAD survivors' challenging recovery process. 11,19 Patients with SCAD in the present study were more likely than their counterparts without SCAD to self-report having a history of anxiety or depression, prior to their cardiac event. This is perhaps not surprising, given that emotional stress has been identified as a precipitator of acute SCAD events. ...
Purpose:
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute myocardial infarction (AMI), particularly in younger women without classic cardiac risk factors. Spontaneous coronary artery dissection is considered to be particularly stressful; however, few studies have quantified SCAD survivor stress levels. This study compared anxiety, depression, and distress levels in SCAD and non-SCAD AMI patients.
Method:
A sample of 162 AMI (35 [22%] SCAD) patients was recruited from hospitals and via social media, in Australia and the United States. All had had their AMI in the past 6 mo. Participants completed an online questionnaire comprising the Generalized Anxiety Disorder-2 (GAD2), Patient Health Questionnaire-2 (PHQ2), Kessler-6 (K6), and Cardiac Distress Inventory (CDI). T-tests, χ2 tests, Mann-Whitney tests, and analysis of covariance were used to compare SCAD and non-SCAD samples. Logistic regression was used to identify the unique predictors of anxiety, depression, and distress, controlling for relevant confounders.
Results:
Patients with SCAD were more commonly female and significantly younger than non-SCAD patients. Patients with SCAD scored significantly higher on the GAD2, PHQ2, K6, and CDI and a significantly larger proportion was classified as anxious, depressed, or distressed using these instruments. In logistic regression, together with mental health history, having had an SCAD-AMI predicted anxiety, depression, and distress, after controlling for female sex, younger age, and other confounding variables.
Conclusion:
This study supports the view that anxiety, depression, and distress are more common after SCAD-AMI than after traditional AMI. These findings highlight the psychosocial impacts of SCAD and suggest that psychological support should be an important component of cardiac rehabilitation for these patients.
... A primary source of uncertainty among patients with cardiac conditions is inadequate provision of information, with patients often reporting that they have received inadequate or conflicting information regarding their illness (Wang et al, 2008;Murphy et al, 2015;Wagers et al, 2018). Without adequate information, patients can struggle to make sense of their illness, whether this be ambiguous symptoms, ill-defined causes, confusing medications and treatments, or unpredictable rates of recovery or recurrence (Almgren et al, 2017;Iles-Smith et al, 2017;Murphy et al, 2022). ...
... The relative rarity of this disease means that information about its causes, management and treatment are often ill-defined (Hayes et al, 2020;Murphy et al, 2022). Patients who have experienced spontaneous coronary artery dissection have reported being given very little information relating to the cause of their disease, its management and prognosis (Wagers et al, 2018;Murphy et al, 2022). Without this information, patients experience uncertainty surrounding almost all aspects of their illness, reporting that navigating this uncertainty is one of the greatest challenges of the condition (Bouchard et al, 2021;Murphy et al, 2022). ...
Illness uncertainty is a common experience across many chronic and acute conditions. Patients with cardiac conditions may experience uncertainty in relation to various aspects of their illness, including its causes, management and prognosis, as well as uncertainty about the future more broadly. There are several contributors to illness uncertainty among these patients, many of which are related to patient factors, such as previous expectations of the illness, sensitivity to physical symptoms and intolerance of uncertainty. Service factors, such as inadequate provision of information, can also contribute to illness uncertainty. Heightened illness uncertainty may result in negative psychological, cognitive and behavioural outcomes. Fears related to the future, specifically fear of disease progression and recurrent events, play an important role in how illness uncertainty is experienced by patients with cardiac conditions. This article presents an overview of illness uncertainty and its impact on cardiac recovery.
... SCAD is associated with underlying systemic vascular conditions such as fibromuscular dysplasia (FMD), connective tissue disorders, migraine headache, and inflammatory disorders [3][4][5][6][7][8]. Emotional stress and physical exertion are often precipitating factors to SCAD events [4][5][6][8][9][10][11]. SCAD is also associated with peripartum status [8,12]. ...
... Emerging evidence suggests that SCAD is a particularly stressful event, with high rates of anxiety and depression [10,[14][15][16][17], stress, burnout and fatigue [11,17], and post-traumatic stress [15,17] reported in quantitative studies. There is some evidence that SCAD survivors have higher levels of anxiety, depression and distress than those who have typical AMI due to atherosclerotic coronary artery disease [16], although a recent study did not support this [18]. ...
... In the absence of atherosclerosis and traditional risk factors for cardiovascular disease, SCAD comes as a shock to survivors and is not suited to traditional lifestyle management approaches typically seen in cardiac rehabilitation (CR) settings [20,21]. Evidence also suggests that the information provided to SCAD survivors is 'insufficient or inadequate' [10], with a reliance on the Internet for information [10]. ...
Spontaneous coronary artery dissection (SCAD) is an increasingly recognised cause of acute myocardial infarction, particularly in younger women without classic cardiac risk factors. While recent quantitative studies have noted high anxiety and depression in SCAD survivors, the full range and extent of psychosocial impacts of SCAD is unknown. The present study used a qualitative approach to investigate the psychosocial impacts of SCAD in Australian SCAD survivors. Focus group participants were recruited as part of a larger study of SCAD survivors currently being undertaken by the Victor Chang Cardiac Research Institute. Thirty SCAD survivors participated in one of seven online focus groups, conducted using a semi-structured format. Focus group duration was 1.5 hours. Each was digitally recorded and transcribed. Data were analyzed thematically according to recommended guidelines. One over-arching theme, five main themes and 26 sub-themes were identified. The over-arching theme related to lack of information, while the five main themes related to emotional impacts, issues with self-management, issues with family, impacts on work life, and the need for psychosocial support. The ‘emotional impacts’ theme comprised 11 sub-themes, namely shock and disbelief, confusion and uncertainty, unfairness, fear and anxiety, loss and grief, isolation and loneliness, guilt, invalidation and embarrassment, depression, vulnerability, and frustration. Findings are discussed in light of relevant psychological theories. This qualitative study extends previous quantitative investigations of SCAD survivors by providing an in-depth understanding of the complex, inter-related and highly distressing impacts of SCAD. The findings point to the urgent need for a coherent approach to information provision, the development and delivery of SCAD-specific cardiac rehabilitation programs, and the provision of psychosocial support programs for SCAD survivors.
... This study is a preplanned secondary analysis of data collected from a survey conducted regarding SCAD survivors' experiences seeking treatment for SCAD and post-SCAD recovery. 21 At the time the survey was conducted, it represented the largest sampling of SCAD survivors' experiences interacting with the health care system. The primary objective of this study is to compare the experiences and perceptions of interactions with ED staff across SCAD survivors of younger and older age cohorts. ...
... Demographics and participant characteristics. As part of the full survey battery for the parent study, 21 participants completed questions about their identified gender, age at the time of first (or only SCAD), and number of lifetime SCAD events. Participants also provided information about their efforts to seek medical care. ...
... Detailed demographics regarding the study sample are provided in a prior publication. 21 In brief, N = 409 individuals provided informed consent to participate; of those, n = 9 participants identified their gender as ''male,'' n = 367 participants identified their gender as ''female,'' and n = 33 participants did not provide a response regarding gender. As this study is primarily concerned with evaluating discrepancies in care between younger and older female SCAD cohorts, and because there were too few men represented in the sample to make meaningful comparisons across male and female experiences, only data from the 367 participants who reported female gender were further analyzed. ...
Background: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic etiology of acute coronary syndrome (ACS) that primarily affects younger women with few traditional cardiovascular disease risk factors. The primary objective of this study was to evaluate how younger age impacts the perception of care women receive in the emergency department (ED) at the time of their first or only SCAD. Methods: SCAD survivors were recruited using SCAD Alliance social media platforms to complete a one-time online survey regarding their experiences of seeking treatment for SCAD in the ED and their post-SCAD recovery. A total of 409 participants consented to participate in the parent study and data collected from the 367 participants who reported female gender were further analyzed. Results: Fewer participants <50 years old than would be expected under the null hypothesis (i.e., 65.5% observed vs. 71.2% expected, p = 0.009) reported perceived serious treatment by ED staff, more participants <50 years than would be expected under the null hypothesis (i.e., 12.0% observed vs. 9.3% expected, p = 0.049) reported perceived dismissive treatment by ED staff, and more participants <50 years than would be expected under the null hypothesis (i.e., 13.3% observed vs. 10.8% expected, p = 0.02) reported discharge from the ED without a diagnosis. Conclusions: Results of this study highlight the different experiences of younger SCAD survivors' engaging with providers in the ED. Further research regarding strategies for increasing ED providers' clinical interrogation of SCAD when treating and evaluating younger female patients presenting with ACS symptoms is indicated.
