title: The First Dedicated Cardiac Rehabilitation Program for Patients With Spontaneous Coronary Artery Dissection: Description and Initial Results.
abstract: BACKGROUND
  Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in women, but the role of rehabilitation after SCAD is unclear.
  
  
  METHODS
  We designed a dedicated SCAD cardiac rehabilitation (SCAD-CR) program for our SCAD survivors at Vancouver General Hospital. This program encompasses a multidisciplinary approach including exercise rehabilitation, psychosocial counselling, dietary and cardiovascular disease education, and peer group support. Exercise and educational classes were scheduled weekly with a targeted participation of 6 months. Psychosocial counselling, mindful living sessions, social worker and psychiatry evaluations, and peer-group support were offered.
  
  
  RESULTS
  We report our first consecutive cohort of 70 SCAD women who joined SCAD-CR from November 2011 to April 2015. The average age was 52.3 ± 8.4 years. Mean participation duration was 12.4 ± 10.5 weeks; 28 completed 6 months, 48 completed ≥ 1 month. At entry, 44 (62.9%) had recurrent chest pains and average metabolic equivalents on exercise treadmill test was 10.1 ± 3.3. At program exit, the proportion with recurrent chest pains was lower (37.1%) and average metabolic equivalents was higher 11.5 ± 3.5 (both P < 0.001). There was a significant improvement in the STOP-D depression questionnaire, with mean scores of 13.0 ± 1.4 before and 8.0 ± 1.7 after the SCAD-CR (P = 0.046). Twenty (28.6%) social worker referrals and 19 (27.1%) psychiatry referrals were made. Mean follow-up was 3.8 ± 2.9 years from the presenting SCAD event, and the major cardiac adverse event rate was 4.3%, lower than our non-SCAD-CR cohort (n = 145; 26.2%; P < 0.001).
  
  
  CONCLUSIONS
  This is the first dedicated SCAD-CR program to address the unique exercise and psychosocial needs of SCAD survivors. Our program appears safe and beneficial in improving chest pain, exercise capacity, psychosocial well-being and cardiovascular events.
authors.affiliation: Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Annie Y
authors.initials: AY
authors.lastname: Chou
authors.affiliation: Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Roshan
authors.initials: R
authors.lastname: Prakash
authors.affiliation: Division of Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rajala
authors.affiliation: Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Taira
authors.initials: T
authors.lastname: Birnie
authors.affiliation: Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Saul
authors.initials: S
authors.lastname: Isserow
authors.affiliation: Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Taylor
authors.affiliation: Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ignaszewski
authors.affiliation: Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Sammy
authors.initials: S
authors.lastname: Chan
authors.affiliation: Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Starovoytov
authors.affiliation: Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: jsaw@mail.ubc.ca.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Saw
mesh_terms: D001955:British Columbia / Q000453:epidemiology; D003330:Coronary Vessel Anomalies / Q000453:epidemiology / Q000534:rehabilitation*; D003376:Counseling / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011379:Prognosis; D015397:Program Evaluation / Q000592:standards*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014652:Vascular Diseases / Q000151:congenital* / Q000453:epidemiology / Q000534:rehabilitation