Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh EH11 4BN, UK.
School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.
Eur J Cardiovasc Nurs. 2022 Oct 14;21(7):665-676. doi: 10.1093/eurjcn/zvac009.
Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction, particularly among women. Spontaneous coronary artery dissection survivors may not know what physical activity is safe and effective, and there may be a psychosocial burden of living with a SCAD diagnosis.
This review aimed to determine the evidence regarding physical activity, cardiovascular risk factors, or associated factors, and the psychosocial impact of SCAD for SCAD survivors after hospital discharge.
A systematic review was completed in accordance with PRISMA guidelines.
We searched Medline, Embase, CinAHL, PsychInfo, and Google Scholar until November 2021.
Outcomes of interest were physical activity participation levels, cardiovascular risk factors and associated risk factors, and psychosocial recovery from SCAD. We included any study (qualitative or quantitative) that reported data pertinent to understanding the impact of SCAD on physical activity and psychosocial aspects of recovery. We also included papers that reported cardiovascular risk or associated risk factors where studies reported outcomes of SCAD survivors. We excluded papers that only provided information on in-hospital management. Any reports that were non-empirical were excluded.
The review included 28 studies. These used a range of methods. None were randomized controlled trials. There were 4167 SCAD participants although some were sourced from the same SCAD registries, so they may not be unique. They were mainly female (n = 3897, 93.5%, range = 57.7-100%), with mean age 48.0 ± 9.8 years at index event. Participants mostly came from the USA, Canada, or The Netherlands. We found very limited evidence for cardiorespiratory fitness improvements following cardiac rehabilitation (CR). Existing CR was not tailored to SCAD specific needs and SCAD survivors lacked guidance about appropriate physical activity. Some participants had high levels of psychosocial distress. Spontaneous coronary artery dissection survivors highlighted the need for tailored support that included family members. Many SCAD survivors have traditional risk factors including hypertension, hyperlipidaemia, and overweight/obesity. Chest pain following SCAD is common.
There is an urgent need to develop physical and psychological recovery programmes for SCAD survivors and test effectiveness via randomized controlled trials. Psychosocial support is particularly required, given the high burden of psychosocial issues.
Prospero CRD42021254798.
自发性冠状动脉夹层（SCAD）作为心肌梗死的一个重要病因，越来越受到重视，尤其是在女性中。SCAD 幸存者可能不知道何种体力活动既安全又有效，而且确诊 SCAD 后可能会存在心理社会负担。
本综述旨在确定 SCAD 幸存者出院后的体力活动、心血管危险因素或相关因素以及 SCAD 的心理社会影响方面的证据。
根据 PRISMA 指南进行系统综述。
我们检索了 Medline、Embase、CinAHL、PsychInfo 和 Google Scholar，检索截至 2021 年 11 月。
我们感兴趣的结局是体力活动参与水平、心血管危险因素和相关危险因素以及 SCAD 后的心理社会恢复。我们纳入了任何报告与了解 SCAD 对体力活动和心理社会恢复方面的影响相关数据的研究（定性或定量研究）。我们还纳入了报告 SCAD 幸存者结局的报告心血管风险或相关风险因素的论文。我们排除了仅提供住院管理信息的论文。任何非实证的报告都被排除在外。
本综述纳入了 28 项研究。这些研究使用了多种方法，但没有随机对照试验。共有 4167 例 SCAD 参与者，尽管其中一些来自相同的 SCAD 登记处，因此他们可能并非独一无二。他们主要为女性（n=3897，93.5%，范围 57.7-100%），平均年龄为 48.0±9.8 岁。参与者主要来自美国、加拿大或荷兰。我们发现心脏康复（CR）后心肺适能改善的证据非常有限。现有的 CR 并未针对 SCAD 的具体需求进行定制，SCAD 幸存者缺乏关于适当体力活动的指导。一些参与者存在较高水平的心理困扰。SCAD 幸存者强调需要量身定制的支持，包括家庭成员。许多 SCAD 幸存者有高血压、高脂血症和超重/肥胖等传统危险因素。SCAD 后胸痛很常见。
迫切需要为 SCAD 幸存者制定身体和心理康复计划，并通过随机对照试验测试其有效性。鉴于心理社会问题负担沉重，特别需要心理社会支持。
PROSPERO CRD42021254798。
