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Safety and Outcomes of cardiac rehabilitation for patients with spontaneous coronary artery dissection

Hafiz Muhammad Imran, Arlene Gaw, Loren Stabile, Nishant R. Shah, Gaurav Choudhary, Wen-Chih Wu
Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA

DOI: 10.2340/20030711-1000001

Abstract

Objective: To evaluate the safety and outcomes of aerobic and resistance training in patients undergoing cardiac rehabilitation after spontaneous coronary artery dissection.
Methods: Eleven patients with spontaneous coronary artery dissection at 2 academic centres were studied retrospectively during cardiac rehabilitation from July 2013 to September 2017. Patients underwent maximal effort exercise testing at enrollment and discharge per institutional protocol. Patients were prescribed individualized exercise regimens based on stress test results, stress management with a behavioural psychologist, and diet counselling with a nutritionist. Resistance training was introduced during weeks 3–5 with close blood pressure monitoring.
Results: Ten patients who completed cardiac rehabilitation showed improvements in aerobic exercise capacity and exercise duration. For resistance training, patients increased the total number of resistance exercise modalities, repetitions, or both. After cardiac rehabilitation, significant improvements were found in exercise capacity, Mental Composite Score, Physical Composite Score, anxiety measured by Generalied Anxiety Disorders (GAD-7), and positive affect. During a mean follow-up of 14 months, no patients had any recurrent dissection or major adverse cardiac events.
Conclusion: Cardiac rehabilitation is safe and improves functional status, anxiety, positive affect and quality of life in patients with spontaneous coronary artery dissection. Future studies should explore ways to further improve the psychosocial and functional status of these patients.

Lay Abstract

Objective: Given paucity of literature, we studied safety and outcome of cardiac rehabilitation (CR) in patients after spontaneous-coronary-artery-dissection (SCAD)
Design: Retrospect cohort design using medical record review
Subject/patients: Eleven patients with SCAD diagnosed by coronary angiography during 2013-2017 who were enrolled in a hospital-based-CR program.
Method: CR in SCAD consisted of individualized exercise regimens, stress management, and diet counseling by a multi-disciplinary team. Training started with aerobic exercise for 3-5 weeks followed by resistance training while maintaining a blood pressure <140/90 during exercise. Change from baseline in stress test METs (n=8), CR exercise duration (n=10), and psychosocial scores (n=9) were compared using paired-T-tests.
Results: 8/11 patients completed 36 CR sessions, two completed 20 sessions, and one patient dropped-out after initial session. At the time of CR completion, there was improvement in CR exercise duration (26.6 to 40.2 minutes, p<0.01), number and repetition of CR resistance exercises, METs achieved during stress test (0.8+ 0.04 METs, p=0.05), Mental-Composite-Score (9.5 + 7.8 p=0.04), Physical-Composite-Score (8.9 + -3.5, p=0.01), and GAD-7 Anxiety score (-4.4 + -3.3, p=0.03). There were no major adverse cardiac events during 14 months of follow-up.
Conclusion: CR is safe and effective in improving physical and psychosocial function after SCAD.

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