The Effect Of Occupational Stress On The Prognosis Of Patients With Acute Coronary Syndrome

Objectives:Coronary heart disease is a serious threat to human health.A large number of studies abroad have confirmed that occupational stress affects the occurrence and development of coronary heart disease,but there are few studies on the association between occupational stress and the incidence and prognosis of coronary heart disease in Chinese patients.The aim of this study is to detect the relationship between occupational stress and the prognosis of acute coronary syndrome(ACS)by investing the effects of different occupational stress levels on heart rate variability(HRV),quality of life(QOL)and physical recovery in patients with ACS.Methods:1 The participants who were admitted to the Department of Cardiology of the First Affiliated Hospital of Kunming Medical University due to their first non-fatal ACS from January 2019 to December 2019,with fixed paid occupations were voluntarily enrolled in the study.All the participants signed information consent and have been set up personal files.2 Basic data of participants were collected during hospitalization,which included demographic characteristics,clinical data,family history of cardiovascular disease,past medical history,personal history,etc.3 Occupational stress of patients was assessed by Job Content Questionnaire(JCQ)and Effort Reward Imbalance Questionnaire(ERIQ)while in hospital.Based on the ratio of demand to control in JCQ or effort to reward in ERIQ,all participants could be respectively divided into two groups:high occupational stress group(ratio greater than 1)and low occupational stress group(ratio less than or equal to 1).4 Participants were followed up for one month after discharge.The HRV was analyzed by 24-hour holter monitoring.Medical Outcomes Study 8-item short-form(SF-8)and Seattle Angina Questionnaire(SAQ)were used to evaluate the quality of life.And all participants were required to perform a physical capacity test named Short Physical Performance Battery(SPPB)to assess physical recovery.5 All data were statistically analyzed to compare the differences of HRV,QOL and physical recovery between patients with high occupational stress and those with low occupational stress.Multiple linear regression models were used to analyze the effects of occupational stress on HRV indicators,QOL,and physical recovery after adjusting confounding factors.Results:1 A total of 65 patients were included in this study,2 patients withdrew halfway,and 63 cases were actually followed up.According to different dimensions of JCQ and ERIQ scores before discharge,37 patients in the high occupational stress group and 26 patients in the low occupational stress group under the JCQ model;44 patients in the high occupational stress group and 19 patients in the low occupational stress group under the ERI model.Two models with high occupational stress were defined as significant high occupational stress group,both models with low occupational stress were defined as significant low occupational stress group,and only one model with high occupational stress was defined as general occupational stress group,including 28 patients in the significant high occupational stress group,25 patients in the significant low occupational stress group and 10 patients in the general occupational stress group.2 The parameters of HRV time-domain indicator and frequency-domain indicators of high occupational stress patients were significantly lower than those of low occupational stress group(P<0.05).Multiple linear regression analysis showed that the frequency-domain indicators including Ln(TP),Ln(ULF),Ln(VLF)and Ln(HF)in the significant high occupational stress group were significantly lower than those in the significant low occupational stress group(P<0.05).3 The SF-8 scale scores and SAQ scores including PL,AS,AF,TS,and DP scores in high occupational stress group were significantly lower compared with low occupational stress group(P<0.05).Multiple linear regression analysis showed that both physiological and psychological scores of SF-8 scale and SAQ-PL scores,SAQ-AS scores and SAQ-DP scores in the significant high occupational stress group were significantly lower than those in the significant low occupational stress group(P<0.05).4 Compared with low occupational stress group,there was no significant difference in SPPB scores of high occupational stress group(P>0.05).Conclusion:1 The HRV parameters of ACS patients with high occupational stress are lower than that of patients with low occupational stress.Occupational stress mainly affects the frequency-domain indicators of HRV.The higher the occupational stress,the lower the heart rate variability.2 ACS patients with high occupational stress have lower quality of life than patients with low occupational stress,mainly including greater subjective physical limitation,worse mental health,more unstable angina,and lower disease perception.The higher the occupational stress,the lower quality of life of patients.3 High occupational stress may adversely affect the prognosis of patients with ACS.