Andrew Steven

The White Dishdasha is more than just a garment; it is a symbol of tradition, culture, and comfort that continues to thrive across generations in the Middle East.

Background Spontaneous coronary artery dissection (SCAD) mainly affects women under 50 years. SCAD patients have reported that their partners struggle to deal with the diagnosis and how best to support their recovery.Aim To explore how partners were impacted by their loved one’s SCAD event and what they needed to help support recovery.Methods A qualitative study using individual semi-structured interviews via Microsoft Teams. Partners of SCAD patients were recruited between May-August 2024 via BeatSCAD social media advertising. Interview topics included their experiences of partner’s SCAD events, impact and support requirements. Interviews were recorded, transcribed verbatim and thematically analysed.Fourteen participants were recruited The majority were male (n=12, 85.7%) and the median age was 52 (interquartile range 16) years. Three overarching themes were developed: 1) Emotional trauma. The unexpected nature of SCAD, often in the absence of cardiovascular risk factors and at a young age, resulted in shock, fear of recurrence, and anxiety about ongoing chest pain and the impact of SCAD on their loved one. This was exasperated by the unknown causes of SCAD and limited understanding of medication regimes. 2) Extreme coping responses. Participants did not want to leave their partners alone and struggled to maintain normal work/routines. This resulted in measures like tracking the SCAD survivor’s location via mobile phone, giving neighbours access to their home and purchasing a defibrillator in case of further events. Partners took on more strenuous household tasks and childcare responsibilities. 3) Support and information needs. Participants required clear explanations from healthcare professionals about their partner’s event and access to informative resources including information about what SCAD is, what treatments are appropriate and what to expect during recovery.Conclusion Partners of SCAD patients are traumatised by the uncertainties associated with SCAD and this could be addressed by improving information available to them.

Background Spontaneous coronary artery dissection (SCAD) primarily affects women. Despite good cardiovascular outcomes patients report high levels of psychological distress and post-SCAD chest pain. SCAD patients attend cardiac rehabilitation (CR), but many feel it does not meet their unique needs.Aim To co-design a SCAD specific recovery intervention.Methods A person-centred design approach was used. An initial scoping review exploring the recovery process was used to create guiding principles for the intervention co-design. SCAD patients were recruited via BeatSCAD social media advertising. Participants took part in two online workshops between December 2023 and February 2024. They also completed an online pre-workshop survey about demographics, health and CR attendance. Workshop 1 focused on individual experiences of SCAD, recovery, and psychological and physical impacts. Facilitators made notes that were thematically analysed and used to develop a proposed intervention. In Workshop 2 participants gave detailed feedback on the proposed intervention, which was refined to create the final intervention.Twenty-one participants were recruited The majority were female (n=17, 85.7%). Median age was 48 (range 30–61) years. Most (n=16, 76.2%) had attended CR and of these 14 (87.5%) had completed. A two-phase virtual intervention was co-designed. Phase 1 was a one-hour online consultation with a nurse with specialist SCAD knowledge. This included discussions about recovery expectations, provided medication education and advice, signposted to SCAD resources, was an opportunity to ask clinical questions, and included mindfulness activities. Phase 2 was an 8-week, 5 session, virtual physical activity programme delivered by an exercise/behaviour change professional. It included virtual conversations focused on goal setting, supplemented by the optional provision of a wearable fitness tracker. Virtual coffee mornings also provided optional peer support.Conclusion SCAD patients want virtual recovery interventions containing education, psychological support and tailored physical activity advice. Future testing of the co-designed intervention is required.

Background Spontaneous coronary artery dissection (SCAD) is a myocardial infarction mainly affecting women. It is thought to occur in the absence of cardiovascular risk factors. Traditional cardiac rehabilitation was not designed for SCAD and more tailored interventions may be beneficial.Aim To test a co-designed SCAD online recovery intervention.Methods The online intervention consisted of an initial consultation with a specialist nurse and five exercise counselling sessions over 8-weeks, supported by use of a wearable device. Participants were recruited from the waiting list of the Leicester Hospital SCAD clinic between October 2024 and January 2025. Participants completed questionnaires prior to the initial consultation, and pre and post-exercise counselling intervention (including demographics/health questions and the Warwick Edinburgh Mental Wellbeing Scale), and a remote 6-minute walk test pre and post-exercise counselling intervention. Descriptive analysis of demographic, health and attendance data, and pre and post-tests (Wilcoxon signed rank test and Friedman test with Bonferroni correction) were conducted using SPSSv29.Results Sixty-one patients were screened for eligibility and 51 information packs were posted to potential participants. Thirty-two patients consented, of whom two were ineligible to take part and two did not start. Twenty-eight participants started the study. The majority were female (n=27, 96.4%) and mean age was 55.0±8.2 years. Ten (35.7%) previously smoked, 14 (50.0%) were overweight/obese, 13 (46.4%) had a history of hypertension and 12 (42.9%) of hyperlipidaemia. Twenty-four participants (85.7%) completed the intervention. Median attendance at exercise counselling sessions was 5 (IQR 0). Post-exercise counselling intervention 6-minute walk distance (median=594m) was significantly greater than pre-exercise counselling intervention (median=499m), z = 3.41, p<.001. Mental wellbeing significantly increased during the intervention, χ2 (2) = 13.899, p<.001, between baseline and post-intervention (p=0.008) and between pre- and post-exercise counselling intervention (p=0.004).Conclusion The high completion rate suggests the intervention is highly acceptable. Further testing is required.