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Aims: Patients with acute coronary syndrome (ACS) often experience reduced health-related quality of life (HRQOL), which may be attributable to the disease severity and psychological stress. While illness perception is speculated to be a potential pathway underlying these relationships, evidence supporting this mechanism remains limited. This study aimed to investigate the relationships between disease severity, psychological stress, and HRQOL and whether these relationships are mediated by illness perception in patients with ACS., Methods and Results: Data were collected from June to July 2019 and June to September 2020 in the cardiology departments of four public hospitals in China. Eligible patients completed measures of disease severity, psychological stress, illness perception, HRQOL, and socio-demographic and clinical characteristics. Data were analysed employing hierarchical multiple regression and structural equation modelling. This study included 405 participants (mean age 60.63 years, 67.4% male). After controlling for socio-demographic and clinical covariates, higher levels of disease severity (β = 0.115, P = 0.024) and psychological stress (β = -0.209, P＜0.001) were associated with poorer HRQOL; however, the relationships became non-significant after adding illness perception into the regression model. Structural equation modelling analysis suggested that illness perception played a mediating role between disease severity, psychological stress, and HRQOL, accounting for 45.95% and 65.79% of the total effects, respectively., Conclusion: This study found that illness perception mediated the relationships between disease severity, psychological stress, and HRQOL among patients with ACS. Improving patients' HRQOL should consider its important influencing factors with a focus on promoting positive illness perception., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: This study aimed to explore the mediating roles of mindfulness and illness perception in the effects of a social media-based Mindfulness psyCho-behAvioRal intErvention (MCARE) on depressive and anxiety symptoms among patients with ACS., Methods: This study conducted a secondary longitudinal mediation analysis using data from a randomized controlled trial of the MCARE grogram in patients with ACS. Participants were recruited at two tertiary hospitals in Jinan, China. The MCARE program consisted of six weekly sessions addressing mindfulness training and disease management to facilitate understanding and management of emotions and illness. The analytical sample included participants who completed measures of the primary outcomes, i.e., depression (PHQ-9) and anxiety (GAD-7) and potential mediators, i.e., mindfulness (CAMS-R) and illness perception (Brief-IPQ) at baseline (T0), immediate post-intervention (T1), and 12-week after the commencement of the intervention (T2)., Results: This study included 146 participants (mean age 58.9 years (SD = 8.9), 69.2 % male), including both intervention and control groups. The mediation analysis revealed a significant mediating effect of T1 mindfulness in the relationship between the group and T2 depression symptoms (indirect effect: -0.109, 95 % CI: -0.191, -0.041; P = 0.004), accounting for 26 % of the effect. For T2 anxiety symptoms, T1 illness perception exhibited a significant mediating effect (indirect effect: -0.055, 95 % CI: -0.110, -0.005; P = 0.035), accounting for 22 % of the effect., Conclusions: This study found that mindfulness and illness perception played a mediating role in the effects of the MCARE program on depressive and anxiety symptoms among patients with ACS., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

This study is aimed at assessing the current status of ACS patients' health literacy and medication compliance, analyzing the relationship between the two, and providing ideas for clinically improving the medication compliance of ACS patients and preventing the recurrence of cardiovascular events. ACS patients need long-term medication to prevent vascular restenosis after surgery, and bad living habits and mood swings will affect postoperative recovery, so clinical interventions are needed to help patients establish a healthy lifestyle. The effect of conventional care is not ideal. Therefore, this paper uses regression analysis to analyze the correlation between the health literacy status of ACS patients and the compliance behavior, combines the investigation and experiment to perform regression analysis and uses mathematical statistics to process data. The connection between health literacy level and compliance behavior is discovered via a study, providing a point of reference for future research., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Huanya Liu et al.)

Background: In China, there has been a precipitous increase in the number of percutaneous coronary interventions (PCI) conducted. We sought to characterize the clinical and psychosocial trajectory of PCI patients from the time of procedure through 6 months post, and correlates of adverse cardiovascular events (ACEs)., Methods: In this prospective, observational study, patients from 2 hospitals in Shanghai, China were assessed. At follow-up visits at 1, 3 and 6 months post-PCI, clinical indicators were again extracted from patients' clinical records, including ACEs, and they completed validated surveys assessing self-management, as well as psychosocial indicators (Hospital Anxiety and Depression Scale; Pittsburgh Sleep Quality Index; quality of life [QoL]: SF-12, Seattle Angina Questionnaire [SAQ]). Repeated measures analysis of variance, adjusted for Barthel index and PCI indication, was used to assess change over time in risk factors and psychosocial indicators. Logistic regression was used to explore correlates of ACEs., Results: 610 participants (mean age = 63.3; n = 150, 18.2% female) were recruited, of which 491 (80.5%) were retained at 6 months. 82 (16.7%) had an ACE at any time point, including most commonly angina and stroke (only 1 death). Clinical indicators such as blood pressure (p < 0.031 for both), symptom burden (p < .01 on all subscales) and QoL (p < 0.001 for both, but started quite low) improved over 6 months. Anxiety and depressive symptoms were above threshold, and the latter worsened over time (p < 0.001). With adjustment for age and indication, patients with any ACEs had higher sleep latency (odds ratio [OR] = 1.48; 95% confidence interval [CI] = 1.03-2.10]), and depressive symptoms (OR = 1.20; 95% CI = 1.02-1.41), but lower anxiety (OR = 0.79; 95% CI = 0.67-0.93) compared to those without., Conclusion: Centers may wish to re-visit patient selection criteria and processes for PCI, as well as implement mental health screening and treatment protocols, as can be achieved through cardiac rehabilitation, given how hazardous psychosocial distress is in this population.

Background: Although researchers have shown that prodromal symptoms can predict acute coronary events, the ability of patients with acute coronary syndrome (ACS) to identify these symptoms in a timely manner is limited., Objectives: We aimed to assess prodromal symptoms in Chinese patients with ACS and their responses to symptoms by sex., Design: This cross-sectional, multicenter study involved 5 teaching hospitals in China and included 806 patients admitted for ACS between June 2013 and February 2014. The McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (Chinese version) was used to gather data., Results: Among 806 patients (including 483 women), 688 (85.4%) experienced at least 1 prodromal symptom before ACS onset. Using adjusted logistic regression models, we determined that women were significantly more likely than men to report back pain, between- or under-shoulder blade pain/discomfort, sleep disturbances, anxiousness, or heart racing. The prevalence of generalized chest pain and loss of appetite was higher among men than women. Only 41% of patients attributed their prodromal symptoms to the heart, and women were more likely than men to attribute prodromal symptoms to a heart attack., Conclusions: More than two-thirds of patients with ACS reported at least 1 prodromal symptom, with some significant sex differences. Most patients do not attribute their symptoms to an impending ACS event.

Background: Priority setting and decision-making in relation to self-management of multiple conditions is particularly challenging for both patients and health professionals. The aim of this study was to validate a conceptual model of self-management priority setting and decision-making in multimorbidity and confirm factors that influence self-management prioritizing and decision-making in a sample of patients with acute coronary syndrome and type 2 diabetes mellitus., Methods: This was a qualitative study using deductive directed content analysis. A purposive sample of 21 participants with acute coronary syndrome and type 2 diabetes mellitus that were admitted to a Shanghai hospital were interviewed., Results: Participants provided evidence to confirm all but one of the factors from the conceptual model. Internal factors influencing self-management predominated. Agreement with recommended treatment, functional capacity and perceived synergies, antagonistic effects, or interactions among the conditions and prescribed treatments, was emphasized. The facilitators and barriers to priority setting and decision-making were related to available resources, provider communication and, to a lesser extent, confusion about recommendations, and treatment complexity. Some participants were also concerned about treatment side effects., Conclusions: Internal factors (personal beliefs, preferences, and attitudes) and facilitators and barriers (knowledge, finances, social support, and transportation) were related to changes in priority setting and decision-making and self-management behavior in this sample. Health education, which includes case studies with shifting self-management priorities is recommended, rather than a unique disease-specific focus. Further research, exploring the relationship between these factors and changes in the dominant condition and related management, using valid and reliable instruments that capture these key factors, is recommended.

Purpose: This study sought to examine associations between depression and unhealthy lifestyle behaviors in Chinese patients with acute coronary syndromes (ACS)., Methods: This cross-sectional study included 4043 ACS patients from 16 hospitals across China who participated in the I-Care (Integrating Depression Care in Acute Coronary Syndromes Patients) trial. Patients were enrolled between November 2014 and January 2017. Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9). Five lifestyle behaviors were assessed: smoking, drinking, body mass index (BMI), physical activity, and sleep quality., Results: A total of 135 patients (3.3%) were considered clinically depressed (PHQ-9 ≥10). After adjusting for covariates, physical activity and sleep quality were inversely related to PHQ-9 scores. Adjusted logistic models showed that depressed patients were 1.7 times likely to be physically inactive (OR = 1.74; 95% CI, 1.15-2.64) and 4.6 times likely to have poor sleep quality (OR = 4.60; 95% CI, 3.07-6.88) compared with nondepressed patients. The association of depression with smoking, unhealthy drinking, and unhealthy BMI was not significant after adjustment for demographic characteristics. Higher depression scores were found to be associated with a greater number of unhealthy lifestyle behaviors (P for trend < .001)., Conclusions: The association of depression and unhealthy lifestyles in post-ACS patients suggests that reducing depressive symptoms and improving healthy lifestyle behaviors could potentially improve clinical outcomes in this vulnerable patient population.

Introduction: Acute coronary syndrome (ACS) is one of the leading causes of death. Depression and/or anxiety after ACS is common. Studies from developed countries have reported that the occurrence of anxiety or depression after ACS might increase the risk of cardiovascular events and mortality. However, the results varied, and are limited in developing countries. Therefore, well designed large-scale real-world study is needed to make further clarification. The main objective of this study is to evaluate whether depression or anxiety could affect the prognosis of patients with percutaneous coronary intervention (PCI) post-ACS., Method and Analysis: The study is a prospective, multicentre, cohort study, which will be performed at 12 large hospitals in northwest China and led by the First Affiliated Hospital of Xi'an Jiaotong University. A total of 5000 patients with PCI post-ACS will be enrolled and followed up for 2 years. Their depression and anxiety status will be evaluated with the Patient Health Questionnaire-9 or Generalised Anxiety Disorder-7 Assessment scales during the follow-up. A Cox proportional hazard model will be used to determine if depression/anxiety after PCI increase the risk of cardiovascular events. The impact of antidepression or antianxiety treatment on the cardiac prognosis will be explored as well among the patients with ACS who received the treatment after PCI., Ethics and Dissemination: This study has been approved by the ethics committee of the First Affiliated Hospital of Xi'an Jiaotong University (approval number: XJTU1AF2016LSL-036). The results will be published in research articles or conference papers., Trial Registration Number: NCT03057691., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To describe, from the perspectives of health professionals, the health education currently being provided from hospital admission to discharge to home to patients who present with acute coronary syndrome who also have type 2 diabetes mellitus (T2DM)., Methods: A qualitative study using semistructured interviews was undertaken in the coronary care unit (CCU) of a major hospital in Shanghai, China. Fifteen health professionals (nine registered nurses and six physicians) from the CCU who delivered health education to patients with acute coronary syndrome and T2DM participated. Participants also completed an Education Content Checklist containing topics consistent with existing national guidelines., Findings: Major themes identified included: health education is an essential embedded component of treatment; health education comprises varied strategies to facilitate behavioural change; and barriers and required resources to deliver effective health education., Conclusions: Surviving the initial symptoms and providing immediate treatment is the first step in recovery for patients with acute coronary syndrome and T2DM. Health education is an essential component of the management of these patients, and content and focus that is responsive to the recovery stage of the patient is required. Teaching and supporting strategies appropriate for the inpatient phase prior to discharging to the community phase are required., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Depression and acute coronary syndromes (ACS) are both common public health challenges. Patients with ACS often develop depression, which in turn adversely affects prognosis. Low-cost, sustainable, and effective service models that integrate depression care into the management of ACS patients to reduce depression and improve ACS outcomes are critically needed. Integrating Depression Care in ACS patients in Low Resource Hospitals in China (I-CARE) is a multicenter, randomized controlled trial to evaluate the efficacy of an 11-month integrated care (IC) intervention compared to usual care (UC) in management of ACS patients. Four thousand inpatients will be recruited and then randomized in a 1:1 ratio to an IC intervention consisting of nurse-led risk factor management, group-based counseling supplemented by individual problem-solving therapy, and antidepressant medications as needed, or to UC. The primary outcomes are depression symptoms measured by the Patient Health Questionnaire-9 at 6 and 12 months. Secondary endpoints include anxiety measured by the Generalized Anxiety Disorder-7; quality of life measured by the EQ-5D at 6 and 12 months; and major adverse events including the combined end point of all-cause death, suicide attempts, nonfatal myocardial infarction, nonfatal stroke, and all-cause rehospitalization at yearly intervals for a median follow-up of 2 years. Analyses of the cost-effectiveness and cost-utility of IC also will be performed. I-CARE trial will be the largest study to test the effectiveness of an integrated care model on depression and cardiovascular outcomes among ACS patients in resource-limited clinical settings., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Although there is good evidence that sedentary behavior is associated with poor health outcomes in healthy persons and patients with cardiovascular disease, the mental health consequences of sedentary behavior have not been widely studied. In this report, we conducted a cross-sectional analysis to examine the relation of self-reported sedentary behavior and depression in a sample of 4,043 hospitalized men and women with acute coronary syndrome enrolled in a randomized clinical trial in rural China. Sedentary behavior was assessed by self-report, and depression was assessed with the Patient Health Questionnaire-9 (PHQ-9); a subset of 1,209 patients also completed the Beck Depression Inventory-II. Results revealed that greater sedentary behavior was associated with higher levels of depressive symptoms measured by both the PHQ-9 (p <0.001) and the Beck Depression Inventory-II (p <0.001). Compared with patients who reported that they were seldom sedentary, patients reporting that they were frequently sedentary were 4.7 times (odds ratio 4.73, 95% confidence interval 2.71 to 8.24) more likely to be clinically depressed defined as PHQ-9 scores ≥10 after adjusting for demographic factors, lifestyle behaviors, clinical characteristics, and in-hospital treatments. In conclusion, greater sedentary behavior is significantly related to greater depression in Chinese patients with acute coronary syndrome, independent of physical activity. These findings suggest that strategies to reduce sedentary behavior may improve medical outcomes and reduce risk for depression., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Acute coronary syndromes threaten the lives of patients, and pose a high risk for morbidity and mortality despite advances in treatment. Evidence highlights that effective discharge planning is associated with long-term prognosis of patients., Objectives: The aim of this project was to improve local practice in discharge planning for acute coronary syndrome patients in Huadong Hospital, Shanghai., Methods: Five criteria identified by the Joanna Briggs Institute were used to conduct an audit in the Cardiovascular Ward and Coronary Care Unit of Huadong Hospital, Shanghai. Forty-two nurses and 65 patients were involved. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in health practice were used to ascertain compliance with the criteria before and after the implementation of best practice. The program included three phases and was conducted over five months., Results: The project showed that the compliance rates of in-house education, advice on lifestyle changes, education on discharge medication and left ventricular assessment reached 100%. Psychological screening also attained 97% compliance. There were improvements in the compliance rates of four criteria from 38% to 100%, excluding in-house education which was already 100% compliant., Conclusions: The project achieved significant improvements in establishing evidence-based practice of discharge planning for acute coronary syndrome patients in the Cardiovascular Ward and Coronary Care Unit. Strategies for sustaining best practice will continue to be developed in the future., (The Joanna Briggs Institute.)

Background: Few studies have evaluated age-related predictors associated with the underuse of medications in patients with coronary heart disease (CHD). The objective of this study was to identify age-related differences in the factors associated with the underuse of recommended medications in patients diagnosed with acute coronary syndrome (ACS)., Methods: From August 2009 to April 2011, we recruited 469 consecutive ACS patients from a cardiac center at a university hospital. We divided the patients into older (65 years of age and older, n = 202) and younger groups (younger than 65 years of age, n = 267). Data on socio-demographic characteristics, depressive symptoms, and medication use were obtained from a telephone survey administered 18 to 24 months after hospital discharge. Additionally, we asked the patients to provide reasons for not taking their medications., Results: A significantly increased underuse of medication was noted in older patients compared with younger patients, including aspirin (24.8% vs. 37.1%, p = 0.005), beta-blockers (20.3% vs. 34.8%, p = 0.001), ACE inhibitor/angiotensin receptor blockers (27.2% vs. 36.7%, p = 0.030), and statins (21.8% vs. 29.6%, p = 0.005). Among older patients, the factors associated with the underuse of medications included low education level (odds ratio [OR], 3.93), greater number of comorbidities (OR, 1.64), and total number of discharge medications (OR, 1.31). The reasons provided by older patients for not taking medication included the fact that the medication was considered to be non-essential and the large number of medications. Among younger patients, low income (OR, 3.97) and depression (OR, 2.62) were predictors for underuse of medication, and the reasons provided for not taking medications included high costs and the fear of adverse effects., Conclusions: At least one year after ACS hospital discharge, the underuse of recommended medications is related to low education level, comorbidities, and the total number of discharge medications in elderly patients, whereas underuse in younger patients is associated with low income and depression. The disparities related to these different predictors may have implications for age-related interventions targeting secondary preventions in CHD patients to improve their use of medication.

Background: Patients' knowledge, attitudes, and beliefs toward acute coronary syndrome are important predictors of delay in seeking medical attention. Currently, there is no instrument in China to measure these factors. Without such an instrument, there is limited understanding of the knowledge, attitudes and beliefs of Chinese patients. The Acute Coronary Syndrome Response Index is a validated instrument to measure patients' knowledge, attitudes, and beliefs about the symptoms and responses to acute coronary syndrome., Objectives: The study aims to translate and validate a Chinese version of the Acute Coronary Syndrome Response Index and to assess the knowledge, attitudes, and beliefs of individuals in mainland China with a history of coronary heart disease., Design: Cross-sectional study., Setting: Two tertiary teaching general hospitals and community in Shandong province, Eastern China., Participants: Individuals with a history of coronary heart disease., Method: The Acute Coronary Syndrome Response Index was professionally translated and piloting was undertaken to ensure equivalence of meaning and cultural appropriateness. Two means were used for participant recruitment: (1) direct approach in hospital and (2) advertisement in a popular health magazine in Shandong province. Principal component analysis was performed to examine the construct validity, and internal consistency was assessed using Cronbach's alpha values., Results: 224 participants with coronary heart disease were recruited, including 158 in-patients and 66 individuals living in the community. Participants' mean age was 64.3±13.8 years. The majority of participants (61.7%) were male. Cronbach's coefficient for total scores of the Chinese version of Acute Coronary Syndrome Response Index was 0.81, 0.79 for knowledge, 0.87 for attitudes, and 0.71 for the beliefs scale. Pearson's method of bivariate correlation test demonstrated convergent validity., Conclusion: The Chinese version of Acute Coronary Syndrome Response Index can be considered as a reliable and valid instrument. Further testing of the instrument which is needed to assess the acceptability and to ensure the utility of the instrument is warranted., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Predictors of quality of life in Chinese patients with acute coronary syndrome remain unknown. Between January 2006 and March 2009, a prospective cohort study of 782 patients with acute coronary syndrome was carried out, with follow-up 7 months later. Depression and anxiety symptoms were measured using the Hospital Anxiety and Depression Scale. Quality of life was assessed using the 36-Item Short-Form Health Survey. To identify predictors of decreased quality of life, both the physical and mental component summary scores were analyzed using multiple and ordinal logistic regression. In our quality-of-life model, diabetes mellitus was an independent risk factor for a low mental component summary score. Anxiety symptoms and the baseline mental component summary score were significant independent predictors of a low mental component summary score. Acute myocardial infarction was found to be a risk factor for a low physical component summary score. Anxiety symptoms, baseline physical component summary score, and systolic blood pressure on admission were significant independent predictive factors. Among patients with acute coronary syndrome, those with acute myocardial infarction, diabetes, or a low baseline quality of life need more care and effective intervention to improve their quality of life.

Objective: To demonstrate the current prevalence and treatment status of diabetes mellitus (DM) among inpatients with acute coronary syndrome (ACS) in China., Methods: Sixty-four hospitals, including 32 secondary hospitals and 32 tertiary hospitals were selected for baseline survey. Fifty inpatients diagnosed with ACS were recruited consecutively from hospitals participated in this study. This paper focused on the prevalence and treatment status of DM among inpatients with ACS., Results: (1) Clinical data of 3223 inpatients (average age 65 +/- 11) with ACS were collected during baseline survey, including 2183(67.7%) males and 1040 (32.3%) females. Among them, 39.8% were diagnosed as ST-segment elevation myocardial infarction (MI), 9.2% as non-ST-segment elevation MI, 51.0% as unstable angina, and 27.1% with ACS history. (2) DM was found in 22.6% ACS patients. The prevalence rate of DM was higher in female (26.3%) patients than that in males (20.8%). The rate of DM was the highest (28.0%) in northeast area and lowest (17.7%) in southwest among 7 geographic districts (north, east, south, central, northeast, northwest and southwest parts of the country). Significant difference was observed among these areas. (3) Rate of awareness on DM was 73.1% among patients with DM, with significant differences among various areas. Treatment rate was 62.1% among patients with DM, with the highest (88.6%) seen in northwest and the lowest (78.4%) in central part of China. (4) Rates of prevalence (27.1%), awareness (82.3%) and treatment (86.7%) of DM were higher in recurrent ACS patients than in those without ACS history., Conclusion: Nearly one-forth of the ACS inpatients were having DM, and 15% of the patients with known DM were not on anti-diabetic treatment. It is essential to pay more attention on the treatment of DM for the purpose of secondary prevention on cardiovascular disease.

Objective: To detect the risk factors of quality of life (QOL) in patients with acute coronary syndrome (ACS), so as to help doctors to recognize the risk population with impaired QOL., Methods: 403 hospitalized ACS patients, 252 males and 151 females, aged 67 12, 168 with ST-segment elevation myocardial infarction (STEMI), 4 with non-ST-segment elevation myocardial infarction (NSTEMI), and 74 with unstable angina pectoris (UAP), were surveyed with short-form-36 (SF-36) scale (Chinese version), including physical component summary (PCS) and mental component summary (MCS) so as to analyze the QOL, hospital anxiety depression scales (HADS) so as to detect the anxiety status. Multiple linear regression analysis was conducted to identify the variables associated with QOL., Results: Of the 403 patients 84 (20.8%) suffered from anxiety, 43 (10.7%) suffered from depression, and 144 (35.7%) suffered from depression combined with anxiety symptoms . Age (r = -0.237, P < 0.001), being female (r = -0.183, P < 0.001), depression (r = -0.180; P < 0.001), and anxiety (r = -0.211, P <0. 001) were independent risk factors of physical QOL. Age (r = -0.117, P = 0.01), depression (r =-0.169, P = 0.004), and anxiety (r = -0.215, P < 0.001) were independently negatively correlated with mental QOL. Smoking was unexpectedly a protective factor for MCS (r = 0.157, P = 0.001)., Conclusion: Depression and anxiety are common in patients diagnosed as with ACS, and appear to be related to significant worsening of QOL. The patients being female, with elder age, and suffering from depression and/or anxiety may be with impaired QOL, and need more care and effective intervention.