AHA 2015 by Krittanawong et al from SCAD Mayo Clinic - All Rights Reserved

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Information about AHA 2015 by Krittanawong et al from SCAD Mayo Clinic - All Rights Reserved

Published on May 28, 2016

Author: getnus

Source: slideshare.net

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

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