Prevalence of Anxiety, Depression, and Distress in SCAD and Non-SCAD AMI Patients

Murphy, Barbara; Rogerson, Michelle; Hesselson, Stephanie; Iismaa, Siiri E.; Hoover, Valerie; Grande, Michael Le; Graham, Robert M.; Jackson, Alun C

doi:10.1097/hcr.0000000000000782

Cited by 11 publications

(6 citation statements)

References 53 publications

(236 reference statements)

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“…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].…”

Section: Introductionmentioning

confidence: 99%

Psychosocial and lifestyle impacts of spontaneous coronary artery dissection: A quantitative study

Murphy,

Rogerson,

Le Grande

et al. 2024

PLoS ONE

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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.

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Section: Introductionmentioning

confidence: 99%

Psychosocial and lifestyle impacts of spontaneous coronary artery dissection: A quantitative study

Murphy,

Rogerson,

Le Grande

et al. 2024

PLoS ONE

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“…Some studies mark emotional stress as a trigger for SCAD because it correlates with catecholamines ( 7 , 16 , 33 – 37 ). It is believed that catecholamines may cause structural changes in the arterial wall leading to intimal rupture or disruption of the vasa vasorum, possibly through increased myocardial contractility or vasospasm ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous coronary artery dissection in women in the generative period: clinical characteristics, treatment, and outcome—a systematic review and meta-analysis

Apostolović,

Ignjatović,

Stanojević

et al. 2024

Front. Cardiovasc. Med.

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IntroductionSpontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic separation of the coronary arterial wall.Materials and methodsThis systematic review and meta-analysis is reported following the PRISMA guidelines and is registered in the PROSPERO database. A literature search was focused on female patients in generative period (16–55 of age) with acute coronary syndrome (ACS) caused by SCAD, and comparison from that database NP-SCAD (spontaneous coronary artery dissection in non pregnant women) and P-SCAD (spontaneous coronary artery dissection in pregnant women).Results14 studies with 2,145 females in the generative period with ACS caused by SCAD were analyzed. The median age was 41 years (33.4–52.3 years). The most common risk factor was previous smoking history in 24.9% cases. The most common clinical presentation of ACS was STEMI in 47.4%. Conservative treatment was reported in 41.1%. PCI was performed in 32.7%, and 3.8% of patients had CABG surgery. LAD was the most frequently affected (50.5%). The prevalence of composite clinical outcomes including mortality, non-fatal MI and recurrent SCAD was 3.3% (95% CI: 1.4–5.1), 37.7% (95% CI: 1.9–73.4) and 15.2% (95% CI: 9.1–21.3) of patients. P-SCAD compared to NP-SCAD patients more frequently had STEMI (OR = 3.16; 95% CI: 2.30–4.34; I2 = 64%); with the left main and LAD more frequently affected [(OR = 14.34; 95% CI: 7.71–26.67; I2 = 54%) and (OR = 1.57; 95% CI: 1.06–2.32; I2 = 23%)]; P-SCAD patients more frequently underwent CABG surgery (OR = 6.29; 95% CI: 4.08–9.70; I2 = 0%). NP-SCAD compared to P-SCAD patients were more frequently treated conservatevly (OR = 0.61; 95% CI: 0.37–0.98; I2 = 0%). In P-SCAD compared to NP-SCAD mortality rates (OR = 1.13; 95% CI: 0.06–21.16; I2 = not applicable) and reccurence of coronary artery dissection (OR = 2.54; 95% CI: 0.97–6.61; I2 = 0%) were not more prevalent.ConclusionThe results of this meta-analysis indicated that patients with P-SCAD more frequently had STEMI, and events more frequently involved left main and LAD compared to NP-SCAD patients. Women with NP-SCAD were significantly more often treated conservatively compared to P-SCAD patients. P-SCAD compared to NP-SCAD patients did not have significantly higher mortality rates or recurrent coronary dissection.

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“…Data from a large US national database, including more than 66,000 patients with SCAD, showed that anxiety and depression were less frequent in SCAD patients compared with patients with atherosclerotic MI ( 30 ). Recently, Muphy et al ( 53 ) found that among SCAD patients, there was a higher prevalence of anxiety, depression, and other psychological disturbances compared with atherosclerotic MI. There is a need for further research in this area, utilizing standardized questionnaires completed early after hospital admission and incorporating subsequent psychiatric evaluations.…”

Section: Discussion: Clustering Of Scad Risk Factorsmentioning

confidence: 99%

A review of the risk and precipitating factors for spontaneous coronary artery dissection

Stanojevic,

Apostolovic,

Kostic

et al. 2023

Front. Cardiovasc. Med.

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IntroductionSpontaneous coronary artery dissection (SCAD) accounts for 1%–4% of cases of acute coronary syndrome (ACS). SCAD is caused by separation occurring within or between any of the three tunics of the coronary artery wall. This leads to intramural hematoma and/or formation of false lumen in the artery, which leads to ischemic changes or infarction of the myocardium. The incidence of SCAD is higher in women than in men, with a ratio of approximately 9:1. It is estimated that SCAD is responsible for 35% of ACS cases in women under the age of 60. The high frequency is particularly observed during pregnancy and in the peripartum period (first week). Traditional risk factors are rare in patients with SCAD, except for hypertension. Patients diagnosed with SCAD have different combinations of risk factors compared with patients who have atherosclerotic changes in their coronary arteries. We presented the most common so-called “non-traditional” risk factors associated with SCAD patients.Risk factors and precipitating disorders which are associated with SCADIn the literature, there are few diseases frequently associated with SCAD, and they are identified as predisposing factors. The predominant cause is fibromuscular dysplasia, followed by inherited connective tissue disorders, systemic inflammatory diseases, pregnancy, use of sex hormones or steroids, use of cocaine or amphetamines, thyroid disorders, migraine, and tinnitus. In recent years, the genetic predisposition for SCAD is also recognized as a predisposing factor. The precipitating factors are also different in women (emotional stress) compared with those in men (physical stress). Women experiencing SCAD frequently describe symptoms of anxiety and depression. These conditions could increase shear stress on the arterial wall and dissection of the coronary artery wall. Despite the advancement of SCAD, we can find significant differences in the clinical presentation between women and men.ConclusionWhen evaluating patients with chest pain or other ACS symptoms who have a low cardiovascular risk, particularly female patients, it is important to consider the possibility of ACS due to SCAD, particularly in conditions often associated with SCAD. This will increase the recognition of SCAD and the timely treatment of affected patients.

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Prevalence of Anxiety, Depression, and Distress in SCAD and Non-SCAD AMI Patients

Cited by 11 publications

References 53 publications

Psychosocial and lifestyle impacts of spontaneous coronary artery dissection: A quantitative study

Psychosocial and lifestyle impacts of spontaneous coronary artery dissection: A quantitative study

Spontaneous coronary artery dissection in women in the generative period: clinical characteristics, treatment, and outcome—a systematic review and meta-analysis

A review of the risk and precipitating factors for spontaneous coronary artery dissection

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