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Lee YS, Hayes SN, Best PJ, Gulati R, Gochanour BR, Tweet MS. Early Effects of the COVID-19 Pandemic on Patients in a Virtual Multicenter Spontaneous Coronary Artery Dissection (SCAD) Registry. CJC Open 2024; 6:689-698. [PMID: 38846446 PMCID: PMC11150954 DOI: 10.1016/j.cjco.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/22/2024] [Indexed: 06/09/2024] Open
Abstract
Background The COVID-19 pandemic effects among patients with a history of spontaneous coronary artery dissection (SCAD), a cause of acute coronary syndrome associated with emotional and physical stress, are unknown. Methods For this cross-sectional cohort study, participants of the Mayo Clinic "Virtual" Multicenter SCAD Registry were surveyed about the COVID-19 pandemic. Results Among 1352 participants, 727 (53.8%) completed surveys between June 2, 2021 and September 29, 2021. The majority of respondents (96.7%) were female, with a mean age of 54.9 ± 9.4 years. At the time of completing the survey, which was early in the pandemic, 91 respondents (12.6%) reported having prior COVID-19 symptoms, with < 1% experiencing hospitalization (n = 4) or cardiac complications (n = 6). A total of 14% had ≥ moderate anxiety symptoms, per the General Anxiety Disorder-7 item survey, and 11.8% had ≥ moderate depressive symptoms, per the Patient Health Questionnaire-9 item. Higher stress scores on the Likert scale were correlated with pandemic-related reduction in work hours and/or pay and/or unemployment (P = 0.013), remote work and/or change of job (P < 0.001), and loss of insurance and/or medical coverage (P = 0.025). A higher anxiety level, as measured on the Likert scale, was correlated with pandemic-related remote work and/or change of job (P = 0.007) and loss of insurance and/or medical coverage (P = 0.008). Since the start of the pandemic, 54% of respondents reported having at least monthly chest pain. Chest pain and COVID symptoms were each associated with higher scores on the General Anxiety Disorder-7 item survey and the Patient Health Questionnaire-9 item. Conclusions Early in the pandemic, COVID-19 symptoms, hospitalization, and cardiac complications were uncommon among SCAD patients. The burden of anxiety and depressive symptoms was minimal to mild, similar to that in prior reports. Likert-scale measures of stress and anxiety were higher among persons with work and/or pay reduction and/or unemployment, remote work and/or change of job, and loss of insurance and/or medical coverage. Over half of respondents reported experiencing chest pain, which was correlated with depressive and anxiety symptoms, highlighting an overarching clinical need.
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Affiliation(s)
- Yeonsoo Sara Lee
- Mayo Clinic Alix School of Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Patricia J.M. Best
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Benjamin R. Gochanour
- Division of Clinical Trials and Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Marysia S. Tweet
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Dang Q, Othman F, Sheahen B, Marschner S, Psaltis P, Al-Lamee RK, Szirt R, Chong J, Zaman S. Regional and temporal variations of spontaneous coronary artery dissection care according to consensus recommendations: a systematic review and meta-analysis. Open Heart 2023; 10:e002379. [PMID: 38056913 DOI: 10.1136/openhrt-2023-002379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/01/2023] [Indexed: 12/08/2023] Open
Abstract
AIM The first expert consensus documents on management of patients with spontaneous coronary artery dissection (SCAD) were published in 2018. Worldwide quality of care, as measured by adherence to these recommendations, has not been systematically reviewed. We aim to review the proportion of patients with SCAD receiving consensus recommendations globally, regionally and, determine differences in practice before and after 2018. METHODS AND RESULTS A systematic review was performed by searching four main databases (Medline, Embase, SCOPUS, CINAHL) from their inception to 16 June 2022. Studies were selected if they included patients with SCAD and reported at least one of the consensus document recommendations. 53 studies, n=8456 patients (mean 50.1 years, 90.6% female) were included. On random effects meta-analysis, 92.1% (95% CI 89.3 to 94.8) received at least one antiplatelet, 78.0% (CI 73.5 to 82.4) received beta-blockers, 58.7% (CI 52.3 to 65.1) received ACE inhibitors or aldosterone receptor blockers (ACEIs/ARBs), 54.4% (CI 45.4 to 63.5) were screened for fibromuscular dysplasia (FMD), and 70.2% (CI 60.8 to 79.5) were referred to cardiac rehabilitation. Except for cardiac rehabilitation referral and use of ACEIs/ARBs, there was significant heterogeneity in all other quality-of-care parameters, across geographical regions. No significant difference was observed in adherence to recommendations in studies published before and after 2018, except for lower cardiac rehabilitation referrals after 2018 (test of heterogeneity, p=0.012). CONCLUSION There are significant variations globally in the management of patients with SCAD, particularly in FMD screening. Raising awareness about consensus recommendations and further prospective evidence about their effect on outcomes may help improve the quality of care for these patients.
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Affiliation(s)
- Quan Dang
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Farrah Othman
- The University of Western Australia, Perth, Western Australia, Australia
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Brodie Sheahen
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Peter Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Medical and Health Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | | | - Richard Szirt
- St George Hospital, Kogarah, New South Wales, Australia
| | - James Chong
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
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Bradshaw JC, Saffire L, Valentine J, Logan Weygandt P. Spontaneous Coronary Artery Dissection: A Case Series Reviewing Typical Presentations of an Atypical Pathology. Clin Pract Cases Emerg Med 2023; 7:215-220. [PMID: 38353187 PMCID: PMC10855290 DOI: 10.5811/cpcem.59930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 09/04/2023] [Accepted: 09/18/2023] [Indexed: 02/18/2024] Open
Abstract
Introduction Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction. Patients suffering SCAD are often young women without typical risk factors for atherosclerotic heart disease. Clinicians should maintain a high index of suspicion for SCAD. Case series We report three cases of patients with SCAD from a single physician in a six-month period. Each case is unique and highlights the varied presentations and epidemiological risk factors associated with this condition. Discussion We believe these cases are unique in that they provide insights into the variable presentations and conditions frequently associated with SCAD and will help clinicians maintain a high index of suspicion for this difficult to diagnose and rare cause of type 2 myocardial infarction. We discuss differences in interventional techniques and medical management.
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Affiliation(s)
- Jace C Bradshaw
- Johns Hopkins Hospital, Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland
- Johns Hopkins Hospital, Department of Emergency Medicine, Baltimore, Maryland
| | - Lisa Saffire
- Johns Hopkins Hospital, Department of Emergency Medicine, Baltimore, Maryland
| | - Jake Valentine
- HCA Houston Healthcare Kingwood, Department of Emergency Medicine, Kingwood, Texas
| | - P Logan Weygandt
- Johns Hopkins Hospital, Department of Emergency Medicine, Baltimore, Maryland
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Starrs M, Acker P. Spontaneous coronary artery dissection: An uncommon cause of cardiac arrest in the young. J Am Coll Emerg Physicians Open 2023; 4:e13000. [PMID: 37397183 PMCID: PMC10312130 DOI: 10.1002/emp2.13000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/04/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome that frequently goes undiagnosed due to its rarity and variable presentation. Additionally, patients with SCAD are frequently young and relatively healthy; factors that may inadvertently lower clinical suspicion of serious pathology, thereby causing delayed or missed diagnosis and inadequate management. Our case report describes a young female who presents after cardiac arrest with inconclusive initial labs and diagnostic tests who was ultimately diagnosed with SCAD. Additionally, we briefly review the pathogenesis and risk factors, as well as the diagnostic and management recommendations for SCAD.
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Affiliation(s)
- Mary Starrs
- Department of Emergency MedicineStanford University Medical CenterPalo AltoCaliforniaUSA
| | - Peter Acker
- Department of Emergency MedicineStanford University Medical CenterPalo AltoCaliforniaUSA
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