Related Experiment Video
Updated: Jun 24, 2026
Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders
Published on: February 3, 2021
Regional and temporal variations of spontaneous coronary artery dissection care according to consensus
Quan Dang1, Farrah Othman2,3, Brodie Sheahen1
1Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia.
Insights
Quality of care for spontaneous coronary artery dissection (SCAD) varies globally. Adherence to 2018 consensus recommendations shows significant regional differences, with lower cardiac rehabilitation referrals post-2018.
Area of Science:
- Cardiology
- Vascular Medicine
- Evidence-Based Medicine
Background:
- The 2018 expert consensus documents established guidelines for managing spontaneous coronary artery dissection (SCAD).
- Systematic review of global adherence to these SCAD management recommendations is lacking.
- This study assesses worldwide quality of care for SCAD patients and practice variations before and after 2018.
Conclusions:
- Global management of SCAD patients exhibits considerable variation, especially concerning FMD screening.
- Awareness of consensus recommendations needs enhancement to improve SCAD patient care.
- Further research on the impact of SCAD guidelines on patient outcomes is crucial.
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.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:26Aneurysm III: Interprofessional Care