Stress in Acute Coronary Syndrome: A Cross-Sectional Study in Kelantan and Terengganu, Malaysia

Background: Stress often happens in acute coronary syndrome (ACS) patients, especially during hospitalization. Objectives: The current study intended to identify the prevalence of stress and its associated factors among ACS patients in two selected hospitals in the east coast region of Malaysia. Methods: A total of 400 ACS patients in both hospitals participated in this cross-sectional study. Acute coronary syndrome patients above 18 who can read, speak and understand in Malay and obtained informed consent were included in the study. The study excluded those patients who were intubated, had any altered mental status, were mentally retarded, and had psychological problems. Stress among ACS patients was measured using the validated questionnaire of the Malay version of the Depression Anxiety Stress Scale 21. Logistic regression was used for analysis. Results: Of these ACS patients, 58.5% had stress symptoms. A higher frequency of stress was found in patients of male (63.7%), Malay (82.1%), and married (67.1%). Acute coronary syndrome patients with a history of ischemic heart disease were a strong and independent factor associated with stress (adjusted odds ratio: 1.73, 95% confidence interval: 1.14 - 2.63, P = 0.010). Conclusions: The prevalence of stress in the study population was high and significantly associated with a history of ischemic heart disease. Creating awareness regarding the risk factors of stress is recommended. In addition, policies should be implemented to reduce the risk of stress among patients.