The Importance of Patient-Clinician Collaboration in SCAD Research

This article was authored by Tina Pittman Wagers, MSW, Psy.D, a spontaneous coronary artery dissection (SCAD) survivor, clinical psychologist, faculty member in the department of psychology and neuroscience of University of Colorado Boulder, and board member of the SCAD Alliance.

Two weeks after completing a sprint triathlon, in the summer of 2014, I suffered a spontaneous coronary artery dissection (SCAD) while swimming across a lake in Idaho. I was 52, active, nearly vegan and had no cardiac risk factors. Fortunately, my husband brought me to safety and raced me to an emergency department. An astute ER doctor in the little town of McCall, Idaho, disregarded the fact that I didn’t look like a heart patient. He found irregularities in my EKG and saw my troponin level rising. I was in the cath lab in Boise the next morning and was diagnosed with SCAD. My story ends well, so far, with help from an empathic and SCAD-informed cardiologist willing to consult with SCAD experts. I had tons of support while I recovered and, as a clinical psychologist, I was able to read the scientific literature.

I learned that 80 – 92 percent of SCAD survivors are women, mostly physically active and healthy, with an average age of 42. The etiology of SCAD is unclear, though evidence points to a confluence of factors including hormonal status, connective tissue disease, emotional stress and intense physical exertion. Though SCAD was previously considered rare, recent research has identified SCAD in one to four percent of patients undergoing cardiac catheterization and in perhaps 40 percent of acute myocardial infarctions among women under age 50. I also learned that not all SCAD survivors receive immediate care, or the proper care, and others struggled more as a result. Even though I consider myself lucky in my SCAD outcome so far, uttering phrases like “my cardiologist” and adjusting to the fact that my body cannot do everything I want to do was a shock.

As a clinical psychologist and professor who teaches about women’s mental health, I became interested in the psychosocial issues related to SCAD and joined the board of the SCAD Alliance, a non-profit patient advocacy organization committed to educating patients and physicians about SCAD and fostering SCAD-related collaborative research efforts.

I also had the opportunity to attend ACC’s 66th Scientific Session (ACC.17) this year to participate in a panel on SCAD moderated by Sharonne N. Hayes, MD, FACC, and Jennifer Tremmel, MD, FACC. The progress in the field of SCAD in just the last two and half years is so impressive. I was buoyed by the attendance at this session and the sharp questions that audience members asked. Attendees and panelists are clearly committed to investigating this enigmatic diagnosis, helping SCAD patients get excellent, informed care at the time of their SCAD, and providing patients with current, evidence-based information on SCAD afterwards.

ACC.17 was the largest and most intimidating conference that I had ever attended, but I was elated to meet the movers and shakers in the SCAD world face-to-face. I sensed SCAD researchers felt the same when meeting with me and fellow SCAD survivors. Research in this area will be more effective if patient experiences are considered.

Even some of the less-encouraging news at ACC.17 was important: I met cardiologists who are still convinced that SCAD is rare; they don’t see it in their cath lab or the population they treat. There is much work to be done in terms of education and research, but I have hope. It is hard to overstate the power of the in-person meeting at ACC.17 on the collaborative efforts that are evolving in this area. I am, frankly, giddy about the possibilities.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Prevention, Sports and Exercise Cardiology, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Diet, Exercise, Stress, Sports and Exercise and Congenital Heart Disease and Pediatric Cardiology

Keywords: Cardiac Catheterization, Connective Tissue Diseases, Coronary Vessel Anomalies, Electrocardiography, Emergency Service, Hospital, Mental Health, Myocardial Infarction, Patient Advocacy, Physical Exertion, Research Personnel, Risk Factors, Stress, Psychological, Survivors, Swimming, Troponin, Vascular Diseases, Diet, Vegetarian

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