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Early Effects of the COVID-19 Pandemic on Patients in a Virtual Multicenter Spontaneous Coronary Artery Dissection
Yeonsoo Sara Lee1, Sharonne N Hayes2, Patricia J M Best2
1Mayo Clinic Alix School of Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA.
Insights
COVID-19 symptoms and complications were rare in spontaneous coronary artery dissection (SCAD) patients early in the pandemic. However, pandemic-related stressors increased anxiety and chest pain, indicating a need for clinical support.
Area of Science:
- Cardiology
- Public Health
- Psychology
Background:
- Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome often linked to stress.
- The impact of the COVID-19 pandemic on SCAD patients remains largely unknown.
- Understanding these effects is crucial for managing SCAD patients during public health crises.
Purpose of the Study:
- To investigate the effects of the COVID-19 pandemic on patients with a history of SCAD.
- To assess the prevalence of COVID-19 symptoms, cardiac complications, and psychological distress in this cohort.
- To identify correlations between pandemic-related stressors and psychological outcomes.
Main Methods:
- A cross-sectional cohort study surveyed participants from the Mayo Clinic "Virtual" Multicenter SCAD Registry.
- Surveys were administered between June 2, 2021, and September 29, 2021.
- Standardized questionnaires assessed COVID-19 history, anxiety (GAD-7), depression (PHQ-9), and stress levels.
Main Results:
- Of 1352 participants, 727 completed the survey; 96.7% were female, mean age 54.9 years.
- Early in the pandemic, COVID-19 symptoms (12.6%), hospitalizations (<1%), and cardiac complications (<1%) were uncommon.
- Moderate anxiety (14%) and depressive symptoms (11.8%) were reported. Stress and anxiety correlated with job/income loss and job changes.
- Over half (54%) reported monthly chest pain, associated with anxiety and depressive symptoms.
Conclusions:
- COVID-19 symptoms and cardiac complications were infrequent among SCAD patients early in the pandemic.
- While psychological distress was generally mild, pandemic-related stressors significantly impacted stress and anxiety levels.
- The high prevalence of chest pain, linked to psychological symptoms, underscores the need for integrated clinical care for SCAD patients.
Background:
The COVID-19 pandemic effects among patients with a history of spontaneous coronary artery dissection (SCAD), a cause of acute coronary syndrome associated with emotional and physical stress, are unknown.
Methods:
For this cross-sectional cohort study, participants of the Mayo Clinic "Virtual" Multicenter SCAD Registry were surveyed about the COVID-19 pandemic.
Results:
Among 1352 participants, 727 (53.8%) completed surveys between June 2, 2021 and September 29, 2021. The majority of respondents (96.7%) were female, with a mean age of 54.9 ± 9.4 years. At the time of completing the survey, which was early in the pandemic, 91 respondents (12.6%) reported having prior COVID-19 symptoms, with < 1% experiencing hospitalization (n = 4) or cardiac complications (n = 6). A total of 14% had ≥ moderate anxiety symptoms, per the General Anxiety Disorder-7 item survey, and 11.8% had ≥ moderate depressive symptoms, per the Patient Health Questionnaire-9 item. Higher stress scores on the Likert scale were correlated with pandemic-related reduction in work hours and/or pay and/or unemployment (P = 0.013), remote work and/or change of job (P < 0.001), and loss of insurance and/or medical coverage (P = 0.025). A higher anxiety level, as measured on the Likert scale, was correlated with pandemic-related remote work and/or change of job (P = 0.007) and loss of insurance and/or medical coverage (P = 0.008). Since the start of the pandemic, 54% of respondents reported having at least monthly chest pain. Chest pain and COVID symptoms were each associated with higher scores on the General Anxiety Disorder-7 item survey and the Patient Health Questionnaire-9 item.
Conclusions:
Early in the pandemic, COVID-19 symptoms, hospitalization, and cardiac complications were uncommon among SCAD patients. The burden of anxiety and depressive symptoms was minimal to mild, similar to that in prior reports. Likert-scale measures of stress and anxiety were higher among persons with work and/or pay reduction and/or unemployment, remote work and/or change of job, and loss of insurance and/or medical coverage. Over half of respondents reported experiencing chest pain, which was correlated with depressive and anxiety symptoms, highlighting an overarching clinical need.
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