American Heart Association's Scientific Session 2015

1. Over all
N = 412
CR
N = 269
No CR
N = 85
P-
value
Age, mean (SD), y 50 (10) 50 (9) 51 (11) 0.48
Female, % 95 97 93 0.06
Time from SCAD to survey, mean
(SD), mo
34 (51) 33 (52) 34 (47) 0.81
Caucasian, % 95 91 87 0.28
BMI, mean (SD) 24 (7) 24 (6) 24 (10) 0.64
Hypertension, % 27 24 29 0.33
Diabetes mellitus, % 3 2 4 0.51
Hypercholesterolemia, % 39 41 31 0.20
FMD, % 24 24 17 0.29
Migraine, % 37 38 33 0.50
CNT, No. (%) 5 5 8 0.35
Age at initial SCAD event, mean (SD),
mo
46 (10) 45 (10) 47 (10) 0.49
UA, % 16 15 21 0.32
NSTEMI, % 58 55 65 0.25
STEMI, % 38 41 29 0.14
Cardiac arrest, % 7 8 4 0.34
Ventricular arrhythmia, % 8 9 4 0.29
CR
participants
n=269
CR non-
participants
n=85
P-value
Anxiety and depression, mean ± SD
GAD-7 4.9 ± 4.7 3.9 ± 4.9 0.03
PHQ-9 4.0 ± 3.5 4.0 ± 3.8 0.71
Exercise capacity, %
Aerobic exercise more than 30 minutes per
time (duration)
54 40 0.01
Aerobic exercise at least once a week
(frequency)
80 66 <0.01
Non-aerobic exercise at least one hour a
week
85 79 0.16
Survey Questions
Baseline Characteristics and Selected Outcomes in Patients With Spontaneous Coronary Artery
Dissection (SCAD): Comparison of Cardiac Rehabilitation Participants and Non-Participants
•Mean age of participants at time of SCAD was 46
± 10 years; 95% were female
•76% of participants participated in at least one
CR session, and those users averaged 18 ± 12
sessions
•A majority of CR participants reported physical
and emotional benefits
•The primary reason of patients did not
participate in CR was because their healthcare
provider did not recommend it (67%)
•CR participants had higher mean GAD-7 (4.9 vs.
3.9; p=0.03) and were more likely to increase
their amount of exercise (p<0.01)
Results
•Participation in CR after SCAD was associated with
increased physical and mental health as well as
increased amount of exercise
•Of the quarter of subjects who were CR non-
participants, lack of recommendation for CR by a health
care provider (67%) was the primary reason patients did
not participate
•Higher GAD-7 scores were associated with CR
participation
Discussion
Figure 2: Reasons Given by SCAD Patients for
Not Participating in CR Program
• Among 412 participants in the Mayo Clinic
SCAD Registry enrolled between January 2010
and December 2014, 354 (86%) patients
completed a survey on their CR experiences
• Demographics, self-reported medical history,
GAD-7, PHQ-9, SF-36 Health Survey and details
about participants’ CR participation and
experience were reviewed
• Univariate analyses were performed to
determine the differences between baseline
characteristics and selected outcomes
according to CR participation status
Methods
Table 1: Baseline Characteristics
•There are few data on CR participation and benefit
among SCAD patients
•The majority reported benefits from CR
•Overall CR participation fell short of current guidelines
•Increased CR referral and emphasis by providers of the
benefits and importance of CR may improve
participation by SCAD patients
Conclusions
1. Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, Gersh BJ, Khambatta S, Best PJM,
Rihal CS, Gulati R. Clinical features, management and prognosis of spontaneous coronary artery
dissection. Circulation. 2012;126:579
2. Hayes SN. Spontaneous coronary artery dissection (SCAD): new insights into this not-so-rare
condition. Tex Heart Inst J. 2014;41:295–98
3. Tweet MS, Eleid MF, Best PJM, Lennon RJ, Lerman A, Rihal CS, Holmes DR, Hayes SN and Gulati R.
Spontaneous Coronary Artery Dissection: Revascularization Versus Conservative Therapy. Circulation,
2014
4. Silber TC, Tweet MS, Bowman MJ, Hayes SN, Squires RW. Cardiac Rehabilitation After Spontaneous
Coronary Artery Dissection. J Cardiopulm Rehabil Prev. 2015 Feb 27
References
Figure 1: Geographic Distribution
© 2015 Mayo Foundation for Medical Education and Research
Objectives
• To compare the psychosocial and physiological
characteristics and outcomes of CR in SCAD
patients who participated in CR compared to those
who did not
Figure 3: Perceived Benefits of CR
Chayakrit Krittanawong, MD1, Marysia S. Tweet, MD1, Sarah E. Hayes, B.A2, Rajiv Gulati, MD1, PhD, Ray W. Squires, PhD1, Sharonne N. Hayes, MD1
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, 2Department of Psychology, West Virginia University, Morgantown, West Virginia
Background
• Randomized controlled trials and meta-analyses
have demonstrated the benefits of cardiac
rehabilitation (CR) in patients with acute coronary
syndrome (ACS)
• However, the benefit of CR has not been well studied
in patients with SCAD
Table 2: Selected Outcomes
12%
2%
8%
67%
2%
2%
Too far to travel or no way to get to
rehab facility
Too expensive
No insurance coverage for rehab
program
My healthcare providers did not
recommend rehab program
Too ill to do any physical activities
Too little energy to engage in a rehab
program
45%
82%
75%
Today I am still experiencing the
benefits of participating in CR
Physical health benefits
Emotional benefits
Indicate benefits of
cardiac rehab for you
Emotional benefits
Physical health benefits
Today I am still experiencing the
benefits of participating in cardiac rehab
If no, why did you not attend
Too little energy to engage in a rehab program
Too ill to do any physical activities
My healthcare providers did not recommend
rehab program
Too far to travel or no way to get to rehab facility
No insurance coverage for rehab program
Too expensive