Quality of Care for Spontaneous Coronary Artery Dissection From the Australian-New Zealand SCAD Registry
Quan M Dang1, Mithila Zaheen2, Patrick Pender3
1Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Insights
Adherence to Spontaneous Coronary Artery Dissection (SCAD) care guidelines is low, especially for fibromuscular dysplasia screening. While FMD screening and cardiac rehab referrals improved, antiplatelet therapy use declined in SCAD survivors.
Area of Science:
- Cardiology
- Vascular Medicine
- Public Health
Background:
- Spontaneous Coronary Artery Dissection (SCAD) is an under-recognized cause of Acute Coronary Syndrome (ACS).
- 2018 consensus guidelines recommend antiplatelet therapy, beta-blockers, fibromuscular dysplasia (FMD) screening, and cardiac rehabilitation for SCAD patients.
Purpose of the Study:
- To evaluate adherence to SCAD quality-of-care recommendations.
- To assess changes in clinical practice for SCAD survivors over time.
Main Methods:
- A 23-hospital multicenter cohort study in Australia and New Zealand (2010-2024).
- Included patients aged 18+ with core laboratory-adjudicated SCAD.
- Logistic regression analysis adjusted for clinical factors to assess temporal trends.
Main Results:
- 567 SCAD patients included: 89.1% female, mean age 52.0.
- High adherence to antiplatelet (95.4%) and beta-blocker (80.8%) therapy.
- Low adherence to FMD screening (47.8%) and cardiac rehabilitation referral (76.0%).
- Only 33.3% received all four recommendations.
- FMD screening and cardiac rehab referral increased over time (aOR 1.24, 1.16 respectively).
- Antiplatelet therapy use decreased over time (aOR 0.69).
Conclusions:
- A low proportion of SCAD patients in Australia and New Zealand received comprehensive guideline-recommended care.
- Fibromuscular dysplasia screening rates remain particularly low.
- While FMD screening and cardiac rehabilitation referrals improved, antiplatelet therapy adherence declined.
Background:
Spontaneous coronary artery dissection (SCAD) is an important but under-recognised cause of acute coronary syndrome (ACS). In 2018, the American Heart Association and the European Society of Cardiology published the first consensus documents that recommended the following for patients with SCAD: at least single antiplatelet therapy, beta-blocker therapy, fibromuscular dysplasia (FMD) screening, and cardiac rehabilitation.
Aim:
We aimed to assess adherence to key quality-of-care recommendations for SCAD survivors and changes in practice over time.
Method:
A 23-hospital multicentre cohort study in Australia and New Zealand from 2010 to 2024 included patients aged 18 years and older with an ACS and SCAD confirmed on core laboratory adjudication of invasive coronary angiography. Logistic regression analysis with adjustment for age, sex, type of ACS, percutaneous coronary intervention, left ventricular function, and hypertension was used to assess changes in care over time.
Results:
A total of 567 patients with core laboratory-confirmed SCAD were included, mean age 52.0±10.5, 89.1% female, 66.7% non-ST elevation ACS, 33.3% ST elevation ACS, and 10.9% received percutaneous coronary intervention. Overall, 95.4% of patients received at least one antiplatelet agent, 80.8% were on beta-blocker therapy, 47.8% were screened for FMD, 76.0% were referred to cardiac rehabilitation, and 33.3% received all four recommendations. On multivariable logistic regression modelling, the proportion of SCAD survivors who received at least one antiplatelet reduced over time (adjusted odds ratio [aOR] 0.69; 95% confidence interval [CI] 0.51-0.89), beta-blocker therapy was unchanged (aOR 1.08; 95% CI 0.99-1.18), and FMD screening (aOR 1.24; 95% CI 1.13-1.30) and cardiac rehabilitation referral (aOR 1.16; 95% CI 1.07-1.25) significantly increased.
Conclusions:
A low proportion of Australian and New Zealand patients with SCAD received all recommended care, with particularly low rates of FMD screening. Significant improvements in FMD screening and cardiac rehabilitation referral were seen over time, but this did not apply to antiplatelet therapy.
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