Spontaneous Coronary Artery Dissection Across the Health Care Pathway: A National, Multicenter, Patient‐Informed Investigation

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...

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Published in:Journal of the American Heart Association Vol. 12; no. 24; p. e032141
Main Authors: Bouchard, Karen, Lalande, Kathleen, Coutinho, Thais, Mulvagh, Sharon, Pacheco, Christine, Liu, Shuangbo, Saw, Jacqueline, So, Derek, Reed, Jennifer L., Chiarelli, Alexandra, Stragapede, Elisa, Robert, Helen, Lappa, Nadia, Sun, Louise, Wells, George, Tulloch, Heather
Format: Journal Article
Language:English
Published: England John Wiley and Sons Inc 19.12.2023
Wiley
Subjects:
cardiac rehabilitation
Coronary Angiography - methods
Coronary Vessel Anomalies
Coronary Vessels
Critical Pathways
Female
Humans
Male
Middle Aged
Original Research
patient‐oriented
Prognosis
Risk Factors
spontaneous coronary artery dissection
Vascular Diseases - congenital
Vascular Diseases - diagnosis
Vascular Diseases - epidemiology
Vascular Diseases - therapy
patient‐oriented
spontaneous coronary artery dissection
cardiac rehabilitation
ISSN:2047-9980, 2047-9980
Online Access:Get full text
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Summary: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. 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. 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.
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For Sources of Funding and Disclosures, see page 11.
Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/JAHA.123.032141
This manuscript was sent to Jennifer Tremmel, MD, Associate Editor, for review by expert referees, editorial decision, and final disposition.
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.123.032141