title: The long-term effects of acute triggers of acute coronary syndromes on adaptation and quality of life.
abstract: BACKGROUND
  A proportion of acute coronary syndromes (ACS) are thought to be triggered acutely by physical exertion, emotional stress and other stimuli. We assessed the consequences of triggering for long-term adaptation following ACS.
  
  
  METHODS
  We assessed mental and physical health status in 150 male and 44 female ACS survivors 12 and 36 months after cardiac events using standardised questionnaire measures. Triggers were assessed by interview an average of 2.56 days after hospital admission. Emotional triggers were defined as moderate or intense anger, stress or sadness/depressed mood in the 2 h before symptom onset, while vigorous physical exertion was defined as activity >/=6 metabolic equivalents in the hour before symptom onset. Clinical characteristics, psychiatric history, health behaviours and the Global Registry of Acute Coronary Events (Grace) risk algorithm were also assessed.
  
  
  RESULTS
  Emotional triggers predicted elevated anxiety and poor mental health status at 12 months independently of age, gender, socioeconomic status, ACS presentation, Grace risk scores, pre-admission medication, anxiety in hospital, depression history and symptom recurrence (p<0.001). Effects persisted at 36 months. Emotional triggers were not related to physical health status at follow up. By contrast, impaired physical health status was predicted by vigorous exertion during the trigger period independently of covariates (p=0.019).
  
  
  CONCLUSIONS
  ACS triggering has a long-term impact on adaptation and quality of life, with differential effects of physical and emotional triggers.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Mimi R
authors.initials: MR
authors.lastname: Bhattacharyya
authors.forename: Linda
authors.initials: L
authors.lastname: Perkins-Porras
authors.forename: Anna
authors.initials: A
authors.lastname: Wikman
authors.forename: Andrew
authors.initials: A
authors.lastname: Steptoe
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D005082:Physical Exertion; D011237:Predictive Value of Tests; D011788:Quality of Life; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult