Clinical Research
The First Dedicated Cardiac Rehabilitation Program for Patients With Spontaneous Coronary Artery Dissection: Description and Initial Results

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Abstract

Background

Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in women, but the role of rehabilitation after SCAD is unclear.

Methods

We designed a dedicated SCAD cardiac rehabilitation (SCAD-CR) program for our SCAD survivors at Vancouver General Hospital. This program encompasses a multidisciplinary approach including exercise rehabilitation, psychosocial counselling, dietary and cardiovascular disease education, and peer group support. Exercise and educational classes were scheduled weekly with a targeted participation of 6 months. Psychosocial counselling, mindful living sessions, social worker and psychiatry evaluations, and peer-group support were offered.

Results

We report our first consecutive cohort of 70 SCAD women who joined SCAD-CR from November 2011 to April 2015. The average age was 52.3 ± 8.4 years. Mean participation duration was 12.4 ± 10.5 weeks; 28 completed 6 months, 48 completed ≥ 1 month. At entry, 44 (62.9%) had recurrent chest pains and average metabolic equivalents on exercise treadmill test was 10.1 ± 3.3. At program exit, the proportion with recurrent chest pains was lower (37.1%) and average metabolic equivalents was higher 11.5 ± 3.5 (both P < 0.001). There was a significant improvement in the STOP-D depression questionnaire, with mean scores of 13.0 ± 1.4 before and 8.0 ± 1.7 after the SCAD-CR (P = 0.046). Twenty (28.6%) social worker referrals and 19 (27.1%) psychiatry referrals were made. Mean follow-up was 3.8 ± 2.9 years from the presenting SCAD event, and the major cardiac adverse event rate was 4.3%, lower than our non-SCAD-CR cohort (n = 145; 26.2%; P < 0.001).

Conclusions

This is the first dedicated SCAD-CR program to address the unique exercise and psychosocial needs of SCAD survivors. Our program appears safe and beneficial in improving chest pain, exercise capacity, psychosocial well-being and cardiovascular events.

Résumé

Introduction

La dissection spontanée de l’artère coronaire (DSAC) est une cause importante de l’infarctus du myocarde chez les femmes, mais on en connaît peu sur le rôle de la réadaptation après la DSAC.

Méthodes

Nous avons élaboré un programme de réadaptation cardiaque après la DSAC (RC-DSAC) destiné à nos survivants de la DSAC au Vancouver General Hospital. Ce programme comprend une approche multidisciplinaire dont la réadaptation par l’exercice, le counseling psychosocial, l’enseignement des maladies cardiovasculaires et de l’alimentation, et les groupes de soutien par les pairs. Les séances d’exercices et d’enseignement étaient offertes chaque semaine et visaient une participation de 6 mois. Le counseling psychosocial, les séances sur la vie en pleine conscience, les évaluations au service social et en psychiatrie, et les groupes de soutien par les pairs étaient offerts.

Résultats

Nous présentons notre première cohorte consécutive de 70 femmes ayant une DSAC qui se sont jointes à la RC-DSAC de novembre 2011 à avril 2015. L’âge moyen était de 52,3 ± 8,4 ans. La durée moyenne de participation était de 12,4 ± 10,5 semaines; 28 femmes y ont participé 6 mois, 48 y ont participé ≥ 1 mois. À l’inscription, 44 femmes (62,9 %) avaient des douleurs thoraciques récurrentes. Les valeurs moyennes de l’équivalent métabolique à l’épreuve de marche sur tapis roulant étaient de 10,1 ± 3,3. À la sortie du programme, la proportion de femmes qui avaient des douleurs thoraciques récurrentes était plus faible (37,1 %). Les valeurs moyennes de l’équivalent métabolique étaient supérieures à 11,5 ± 3,5 (P < 0,001 pour les deux). Les scores moyens au questionnaire sur la dépression STOP-D montraient une amélioration significative, soit de 13,0 ± 1,4 avant la RC-DSAC et de 8,0 ± 1,7 après (P = 0,046). Vingt (28,6 %) orientations au service social et 19 (27,1 %) orientations en psychiatrie étaient faites. Le suivi moyen était de 3,8 ± 2,9 ans à partir de la DSAC, et le taux d’événement indésirable majeur était de 4,3 %, soit plus faible que notre cohorte qui n’avait pas participé à la RC-DSAC (n = 145; 26,2 %; P < 0,001).

Conclusions

Il s’agit du premier programme de RC-DSAC destiné à répondre aux besoins particuliers en matière d’exercice et de counseling psychosocial des survivants de la DSAC. Notre programme semble sûr et bénéfique pour réduire les douleurs thoraciques et les événements cardiovasculaires, et améliorer la capacité à l’effort et le bien-être psychosocial.

Section snippets

Methods

We designed a cardiac rehabilitation program in 2011 specifically for women after a SCAD event at Vancouver General Hospital (VGH), for patients who live in Vancouver and the surrounding suburbs in British Columbia. This SCAD-CR program (Table 1) was modified from a standard cardiac rehabilitation program after atherosclerotic MI. A dedicated weekly rehabilitation session was scheduled every Friday, and patients were highly encouraged to attend to benefit from peer-group support. When patients

Results

We report our consecutive series of 70 women with SCAD who joined SCAD-CR since the start of the program from November 2011 to April 2015. The average age was 52.3 ± 8.4 years, and other baseline demographic characteristics are described in Table 3. There was no difference in baseline demographic characteristics compared with the SCAD cohort who did not undergo SCAD-CR (n = 145). Of the SCAD-CR cohort, 56 (80.0%) presented with non-ST elevation MI, and 14 (20.0%) presented with ST-elevation MI

Discussion

To our knowledge, this is the first dedicated SCAD-CR program tailored to the unique exercise and psychosocial needs of SCAD survivors. In this prospectively followed cohort, we found our SCAD-CR program to be safe and beneficial. There was an improvement in exercise capacity and a reduction in the proportion of patients with chest pain at the conclusion of the program. There were also improvements in psychosocial well-being, with reduced depression scores and a trend toward improvement in

Disclosures

Dr Saw received research grants for SCAD research (Canadian Institutes of Health Research, University of British Columbia Division of Cardiology, AstraZeneca, Abbott Vascular, St Jude Medical, and Servier), and speaker honorarium for SCAD (AstraZeneca, St Jude Medical, and Sunovion). The other authors have no conflicts of interest to disclose.

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