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Spontaneous Coronary Artery Dissection and Evidence-Based Medicine
Courtney Jordan Baechler1, Dawn R Witt1, Opema Lohese1
1Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
Insights
Spontaneous coronary artery dissection (SCAD) treatment often falls short of evidence-based medicine (EBM) standards. Patient-reported barriers include misdiagnosis, mental health support, and communication gaps, highlighting the need for improved SCAD care.
Area of Science:
- Cardiology
- Vascular Medicine
- Evidence-Based Medicine
Background:
- Spontaneous coronary artery dissection (SCAD) is increasingly recognized, yet evidence-based medicine (EBM) standards for its treatment are still emerging.
- Many healthcare providers are unfamiliar with established EBM treatment protocols for SCAD, potentially impacting patient care.
- Current EBM standards for SCAD include specific medications, vascular imaging, and cardiac rehabilitation.
Purpose of the Study:
- To determine the frequency of adherence to EBM treatment standards in SCAD patients.
- To identify factors contributing to the failure to meet EBM standards for SCAD treatment.
- To understand patient-reported barriers to optimal SCAD care.
Main Methods:
- Retrospective review of electronic medical records for 115 SCAD patients treated at a tertiary referral hospital between January 1, 2005, and July 6, 2020.
- Phone interviews were conducted with patients who did not meet EBM criteria to explore reasons for non-conformance.
- Data analysis focused on medication adherence, imaging, cardiac rehabilitation, and patient-reported outcomes.
Main Results:
- Only 30% of SCAD patients in the study cohort met current EBM treatment standards.
- Common barriers included medication limitations (e.g., fatigue with beta-blockers), lack of fibromuscular dysplasia imaging in 59% of patients, and challenges with cardiac rehabilitation access.
- Patient interviews revealed significant frustration with SCAD misdiagnosis (39%), inadequate mental health resources (37%), and poor communication regarding follow-up (26%).
Conclusions:
- Adherence to evidence-based medicine standards for spontaneous coronary artery dissection remains low, with only 30% of patients meeting criteria in this 15-year study.
- Patient-reported issues such as misdiagnosis, mental health support, and communication breakdowns significantly impact care.
- Developing unique, patient-informed, and evidence-driven solutions is crucial to improve clinical outcomes for SCAD patients.
Abstract:
Spontaneous coronary artery dissection (SCAD) is a relatively newly diagnosed area, and evidence-based medicine (EBM) standards are emerging and currently include an aspirin, β blocker, clopidogrel, angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker for patients with hypertension, vascular abnormality imaging, and cardiac rehabilitation. Because SCAD is an uncommon condition, many providers are unfamiliar with EBM treatment standards which could affect the implementation of recommended treatment. This study documented the frequency of failure to meet EBM SCAD treatment standards and factors contributing to conformance failure. Patients who presented to a tertiary referral hospital from January 1, 2005, to July 6, 2020, were included. The electronic medical record was reviewed for EBM treatment. Patients who did not meet the criteria of EBM were contacted by phone for a phone interview. The study period included 118 patients with SCAD, 3 of whom (2.5%) died and were not eligible for this study. In the final cohort of 115 patients, the average age was 55 years, female gender (97%) and EBM standards were met in 30%. Of patients who participated in the phone interview, 38 (33%) reported frustration with SCAD misdiagnosis (39%), inadequate mental health resources (37%), and communication failure regarding the need for cardiologist follow-up (26%). Cardiac rehabilitation use was impacted by location, time of day, availability, and cost. The most common medication-limiting factor for β-blocker usage was fatigue (15%). Most (59%) patients did not undergo fibromuscular dysplasia imaging. In conclusion, in this 15-year SCAD study from a single tertiary care hospital SCAD registry, only 30% met the current EBM for SCAD. Unique solutions that are both patient-informed and evidence-driven are needed to achieve the best clinical outcomes.
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