Spontaneous coronary artery dissection in cardiac rehab: an exploration of the lived experiences of patients and the perceptions, knowledge and understanding of healthcare professionals

Background: Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic type of cardiovascular disease (CVD) that affects young and middle-aged women more than men. Many aspects of SCAD, however, remain unclear, including the outcomes of cardiac rehabilitation (CR) and the lived experiences of people with this condition in the programme. Furthermore, the awareness and knowledge of healthcare professionals (HCPs) regarding SCAD may be an important factor in determining patient engagement with rehabilitation services. A longitudinal study examining changes in physical and mental health outcomes of patients with SCAD is yet to be performed. Similarly, an in-depth exploration of HCPs' perspectives on SCAD is also needed.

Objectives: The objectives of this project are to understand the lived experiences of patients with SCAD, examine the knowledge of HCPs about the management of SCAD, and analyse the outcomes of CR on physical activity, diet, body mass index, waist circumference, stress, anxiety, depression and health-related quality of life upon completion of phase III and phase IV CR, and a year post-event.

Methods: A mixed-methods longitudinal observational study will be performed with four time points (pre-phase III CR, post-phase III CR, post-phase IV CR, and a year follow-up after SCAD event). Lived experiences of both male and female patients with SCAD, their pathways of care and barriers to engagement to CR will be explored through semi-structured interviews. Physical activity (short-form IPAQ questionnaire), dietary intake, anthropometric measures (waist circumference and body mass index), stress (PSS-10 questionnaire), anxiety (GAD-7 questionnaire), depression (PHQ-9 questionnaire) and health-related quality of life (EQ-5D-5L questionnaire) will be assessed at each timepoint. Patients with SCAD who are not engaged with CR will be used as a control group. Outcome measures will be compared between two groups using a mixed model ANOVA (time x intervention). A qualitative cross-sectional study using semi-structured interviews with HCPs will explore their understanding and management of SCAD.

Discussion: The findings of this project will indicate weather current CR needs are met in this patient group and what changes need to be made to existing CR services to improve uptake in patients with SCAD. This could lead to a larger clinical trial that examines the effectiveness of tailored CR for this group of patients. Additionally, the information received from HCPs will indicate if there is an unmet educational need regarding SCAD, which may ultimately lead to better recognition, medical and lifestyle management for this patient group.