Psychologist / Associate Professor uOttawa Heart Institute, Canada
Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, disproportionately impacting women (~90%). Clinical guidelines for the management and recovery of patients with SCAD have yet to be developed but scientific statements and expert opinions, including those of patients, clearly indicate that SCAD-specific information and comprehensive cardiac rehabilitation (CR) programming are required. While tailored approaches to meet the needs of patients with SCAD are recommended, at present, no SCAD-specific referral, education and CR pathway for this unique population exists.
METHODS AND RESULTS: To address this gap, our team of nursing, physiotherapy, psychology and CR management staff created a SCAD-specific care pathway from hospitalization to CR discharge to better address the informational, physical and emotional needs of patients post-SCAD. The pathway includes SCAD-specific information and resources provided at the bedside, an automatic referral to CR before discharge, a post-discharge “Living with SCAD” information session, SCAD-specific CR intake assessment, an online link to videos providing answers to 10 frequently asked questions about SCAD, exercise instructions based on the current evidence, referral to specialty CR services as required including psychology, social work, dietician, and vocational rehabilitation, follow-up with CR physician and/or cardiologist, and referral to the Women@Heart peer support program. The purpose of this study is to describe the pathway and report preliminary data from various pathway components. To date, 27 patients attended the “Living with SCAD” webinar and reported improvements in perceived knowledge and confidence in managing their health. Of those with completed pre-post CR data (N=49 patients, 95% female, M age=51.8 years), most patients chose to participate in virtual CR programming, rather than onsite (34.7%). Statistically significant pre-post differences were observed for systolic blood pressure (M difference =-4.1, p=.046), METS (M difference =1.3, p<.001), PHQ depression scores (M difference =-4.1, p=.004) and GAD-7 anxiety scores (M difference =-2.2, p<.001). No differences were detected for cholesterol, triglycerides, or HbA1C. Women@Heart peer support participants (N=30) reported significant improvements in perceived stress scores (M difference =-2.1, p=.044). Patients reported high satisfaction and health improvements with many elements across the care pathway.
Conclusion: By ensuring that multiple elements of information and intervention are addressed, this SCAD-specific care pathway, which facilitates the provision of education, multidisciplinary cardiac rehabilitation programming and peer support, cardiology care and follow-up, may lead to enhance cared for this cardiac population. Further testing and more rigorous evaluations of the impact of the various interventions are required.
