Abstract 4369446: Characteristics Of Cardiac Rehabilitation Referral And Attendance Among Patients With Spontaneous Coronary Artery Dissection: A Report of the iSCAD Registry

Abstract

Cardiac rehab (CR) improves outcomes after ischemic cardiac events, but its role in patients with spontaneous coronary artery dissection (SCAD) remains less understood. Among patients with SCAD, are there demographic or clinical differences between those who are prescribed and/or attend CR versus those who are not? What barriers prevent SCAD patients from attending CR? Demographics, clinical data, and barriers to CR were collected from the prospective multicenter iSCAD Registry. Among 979 patients enrolled in the iSCAD Registry, 742 (75%) were prescribed CR. Among those prescribed CR, there was no difference between sex, race, caregiver status, pregnancy, or number of live births (surrogate for childcare). CR was more likely to be prescribed in patients with a college degree or higher (76% vs 67%, p=0.02). In patients with pregnancy-related SCAD (pSCAD), CR was prescribed less often (10% vs 16%, p= 0.02). In the multivariable analysis, pSCAD (OR 0.39, 0.21-0.73) and history of myocardial infarction (OR 0.60, 0.38-0.96) was negatively associated with CR prescription, while college degree or higher (OR 2.13, 1.13-4.05) and ejection fraction (EF) <50% (OR 3.31, 1.93-5.69) were positively associated with CR prescription. Of the patients prescribed CR, 596 (80.3%) reported attendance. Sex, caregiver status, history of pregnancy, number of live births, history of pSCAD events, and EF were not significantly different between patients who attended CR versus not. White patients more often participated in CR (92% vs 82%, p=0.01). Patients with a college degree or higher were more likely to attend CR (78% vs 68%, p=0.03), while patients with a full-time job were less likely to attend CR (52% vs 57%, p=0.05). Patients with revascularization were more likely to attend CR (PCI 29% vs 13% p=0.01, CABG 4.6% vs 0.7% p=0.03). In the multivariable analysis, female sex was positively associated with CR attendance (OR 2.68, 1.31-5.49), while Black race was negatively associated with CR attendance (OR 0.29, 0.14-0.60). Of the 146 patients who did not attend CR, scheduling issues (35%) was the most frequently cited reason for not attending followed by ‘too easy or too difficult” (16%), distance (11%), and cost (10%). In the iSCAD registry, most patients were prescribed CR and attended. Certain demographic and clinical differences impacted CR prescription and attendance. These differences highlight the need for strategies to improve referral practices and reduce access barriers.