About the Project
Spontaneous coronary artery dissection (SCAD) is increasingly recognised as an important cause of myocardial infarction (MI), particularly among women.1 Women make up 87% to 95% of SCAD events. SCAD is a frequent cause of MI in younger women, with reported mean age of 44- 53 years age.1 The exact mechanism of SCAD is not fully understood, but it is an acute coronary event resulting from development of haematoma within the tunica media leading to separation of the intima or intima-medial complex from the underlying vessel and compressing the true lumen resulting in ischemia and MI.1 Global estimates suggest SCAD is the underlying cause of MI in 22-43% of women <50 years.2
As well as affecting younger women, SCAD frequently occurs in the absence of traditional risk factors associated with MI. Indeed, participating in strenuous physical activity has been associated with incidence of SCAD events in up to 30% of women.3 This can lead to psychological distress, fear and anxiety, which can have devastating and debilitating consequences for SCAD survivors. Consequently, recognising the burden of psychological distress and providing support and ongoing management is highly recommended by leading experts in SCAD.2 This support may include access to physical activity programmes such as cardiac rehabilitation, as fear and hesitancy after a SCAD event are common and may lead to avoidance of all physical activity.4
Cardiac rehabilitation (CR) is a multicomponent intervention recommended after cardiac events.5 Typically, CR includes supervised physical activity sessions, interventions to reduce risk factors, improve psychosocial wellbeing, and increase medication adherence.5 There is strong evidence from randomised controlled trials that cardiac rehabilitation reduces cardiac events and decreases mortality in people who have survived an MI, but this evidence is largely generated in a population with atherosclerotic disease.6 Furthermore, most trials of CR include mostly male participants, typically aged in the mid-sixties.7 Only two small studies have explored the feasibility of SCAD survivors participation in CR. These managed exercise recommendations through conservative guidance that prevented participants from exercising at pre-morbid levels. We recently conducted a qualitative study with women in Scotland to explore their experience of CR and found major limitations and gaps in the delivery of effective recovery for SCAD survivors.8 Our patient advisors highlight the challenges that SCAD survivors have in knowing what exercise is safe and effective for them to undertake and believe that a digital solution for SCAD survivors could provide information and support on both physical and psychological concerns.
The overall objectives of this PhD study are to better understand the recovery process from SCAD and to inform ideal post-event care of survivors of SCAD in Scotland.
This PhD will be supervised by Professor Lis Neubeck, Dr Coral Hanson, and Dr Mark Ross. These leading international experts have extensive experience of leading grants, publications, and supporting students to win prizes and awards. The work delivered by this team has had impact on policy, guidelines and practice.
A first degree (at least a 2.1) ideally in sports science, physiotherapy or nursing with a good fundamental knowledge of cardiovascular health.
English language requirement
IELTS score must be at least 6.5 (with not less than 6.0 in each of the four components). Other, equivalent qualifications will be accepted. Full details of the University’s policy are available online.
· Experience of fundamental statistics
· Competent in MS office suite
· Knowledge of Cardiovascular rehabilitaiton
· Good written and oral communication skills
· Strong motivation, with evidence of independent research skills relevant to the project
· Good time management
Previous experience with publication and preparing reports
Please quote reference SHSC0024 on your application
• Completed application form
• 2 academic references, using the Postgraduate Educational Reference Form (Found on the application process page)
• A personal research statement (This should include (a) a brief description of your relevant experience and skills, (b) an indication of
what you would uniquely bring to the project and (c) a statement of how this project fits with your future direction.)
• Evidence of proficiency in English (if appropriate)
2. Hayes SN, Kim ESH, Saw J, et al. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation 2018; 137: e523-e557. 2018/02/24. DOI: 10.1161/CIR.0000000000000564.
3. Saw J, Starovoytov A, Humphries K, et al. Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes. Eur Heart J 2019; 40: 1188-1197. 2019/01/31. DOI: 10.1093/eurheartj/ehz007.
4. Saw JWL, Starovoytov A, Birnie T, et al. Comparison of psychosocial questionnaires between spontaneous coronary artery dissection (scad) and non-scad populations undergoing cardiac rehabilitation program after myocardial infarction. Journal of the American College of Cardiology (JACC) 2016; 67: 1936-1936. DOI: 10.1016/S0735-1097(16)31937-4.
5. Cowie A, Buckley J, Doherty P, et al. Standards and core components for cardiovascular disease prevention and rehabilitation. Heart 2019; 105: 510-515.
6. Anderson L, Oldridge N, Thompson DR, et al. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. Journal of the American College of Cardiology 2016; 67: 1-12.
7. Doherty P. The National Audit of Cardiac Rehabilitation Quality and Outcomes Report 2019 available at https://www.bhf.org.uk/informationsupport/publications/statistics/national-audit-of-cardiac-rehabilitation-quality-and-outcomes-report-2019 accessed 07/09/2020. 2019.
8. Johnson EL, Neubeck L, Hanson C, Understanding what women want from cardiac rehabilitation- does expectation meet reality? (EJCN under review)
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