Patient Perspectives on Cardiac Rehabilitation and Exercise After Spontaneous Coronary Artery Dissection

BACKGROUND & AIMS: Survivors of spontaneous coronary artery dissection (SCAD) often struggle to resume exercise to previous levels, heightened by a fear of recurrence. Cardiac rehabilitation is recommended after SCAD, however its specific role in supporting or hindering patient engagement with exercise remains unclear. This study aimed to examine how cardiac rehabilitation influences SCAD survivors' engagement in exercise. METHODS: Participants with an angiographically confirmed SCAD within the previous 3 years were purposively recruited from a larger clinical study. Focus groups were conducted via Zoom, recorded and transcribed. Thematic analysis followed an iterative approach with themes finalised through consensus. RESULTS: Twenty-eight SCAD survivors (mean age 54.8±9 years; 71% female; mean time since SCAD 18.1±6.4 months) participated in one of eight 90-minute focus groups. Six themes emerged: safety; validation and belonging; knowledge and education; sense of achievement; motivation; and empowerment. Within each theme, participants described how cardiac rehabilitation could either facilitate or hinder post-SCAD exercise engagement. CONCLUSIONS: Cardiac rehabilitation can either facilitate or hinder post-SCAD exercise engagement. For SCAD survivors, cardiac rehabilitation should be individualised and address exercise fear and avoidance, using informed clinical support, education, and reassurance.