Spontaneous coronary artery dissection: a systematic review of physical and psychosocial recovery following discharge from hospital

Abstract

Background Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction, particularly among women. Spontaneous coronary artery dissection survivors may not know what physical activity is safe and effective, and there may be a psychosocial burden of living with a SCAD diagnosis. Objectives This review aimed to determine the evidence regarding physical activity, cardiovascular risk factors, or associated factors, and the psychosocial impact of SCAD for SCAD survivors after hospital discharge. Design A systematic review was completed in accordance with PRISMA guidelines. Data Sources We searched Medline, Embase, CinAHL, PsychInfo, and Google Scholar until November 2021. Eligibility criteria for study selection Outcomes of interest were physical activity participation levels, cardiovascular risk factors and associated risk factors, and psychosocial recovery from SCAD. We included any study (qualitative or quantitative) that reported data pertinent to understanding the impact of SCAD on physical activity and psychosocial aspects of recovery. We also included papers that reported cardiovascular risk or associated risk factors where studies reported outcomes of SCAD survivors. We excluded papers that only provided information on in-hospital management. Any reports that were non-empirical were excluded. Results The review included 28 studies. These used a range of methods. None were randomized controlled trials. There were 4167 SCAD participants although some were sourced from the same SCAD registries, so they may not be unique. They were mainly female (n = 3897, 93.5%, range = 57.7–100%), with mean age 48.0 ± 9.8 years at index event. Participants mostly came from the USA, Canada, or The Netherlands. We found very limited evidence for cardiorespiratory fitness improvements following cardiac rehabilitation (CR). Existing CR was not tailored to SCAD specific needs and SCAD survivors lacked guidance about appropriate physical activity. Some participants had high levels of psychosocial distress. Spontaneous coronary artery dissection survivors highlighted the need for tailored support that included family members. Many SCAD survivors have traditional risk factors including hypertension, hyperlipidaemia, and overweight/obesity. Chest pain following SCAD is common. Conclusion There is an urgent need to develop physical and psychological recovery programmes for SCAD survivors and test effectiveness via randomized controlled trials. Psychosocial support is particularly required, given the high burden of psychosocial issues. Data registration Prospero CRD42021254798.

Psychosocial impacts of spontaneous coronary artery dissection: A qualitative study

“…Consistent with previous findings [ 10 ], participants commonly turned to the internet in their generally unsuccessful attempts to understand and manage their condition. The present findings also highlight the inadequacy of traditional CR programs for SCAD survivors, pointing to the need for SCAD-tailored CR programs, supporting previous qualitative [ 22 ] and quantitative studies [ 17 , 18 ]. Preliminary evidence suggests that SCAD-tailored CR can improve exercise capacity and psychosocial wellbeing, and provide an avenue for referrals to psychological support [ 37 ].…”

“…Indeed, the findings of the present study point to a clear and urgent need for provision of psychosocial support for SCAD survivors. This again reiterates the findings of a systematic review that reported high levels of distress in SCAD survivors [ 17 ]. SCAD survivors need an opportunity to express their fears and concerns, and to be validated and emotionally supported in their recovery.…”

“…SCAD survivors need consensus regarding management of SCAD, including the role of medications, and guidelines for resumption of activities. A recent systematic review focusing on SCAD recovery similarly reported a need for guidance on resuming physical activity [ 17 ]. The current situation involving inadequate and conflicting information and advice has left SCAD survivors floundering, often leading them to unnecessarily limit their activities, avoid physical exertion and situations which might arouse intense emotions, and abandon prescribed medication regimes.…”

“…Emerging evidence suggests that SCAD is a particularly stressful event, with high rates of anxiety and depression [ 10 , 14 – 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 ].…”

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

“…This study supports the view that patients with SCAD experience more distress, anxiety, and, to a lesser extent, depression than do their AMI counterparts without SCAD, adding to the growing body of knowledge regarding the psychosocial impact of SCAD. [11][12][13][14][15]19,49 These findings underscore the importance of providing survivors of SCAD with tailored information and support to assist with their physical and emotional recovery. Previous research has highlighted the need for professionally-facilitated online support programs for SCAD survivors.…”