Fatigue two months after myocardial infarction and its relationships with other concurrent symptoms, sleep quality and coping strategies

Fatigue, Stress, and Blood Pressure Medication Adherence by Race After Myocardial Infarction

Fatigue and stress may affect medication adherence. This study explored fatigue, stress, and blood pressure (BP) medication adherence in Black and White adults (N= 152) who had experienced a myocardial infarction. Over half of the sample (55%) reported fatigue as moderate to severe. The regression model explained up to 40% of the variance (p < .001) with fatigue and race significantly predicting adherence. Black participants reported fatigue causing distress (r =.40), and White participants reported greater association of fatigue severity-related BP medication adherence (r =.49). Our findings support considering racial differences when evaluating fatigue associated with BP medication adherence.

Associations of multidimensional fatigue with the physical, psychological, and situational factors in outpatients with heart failure: a cross-sectional study

AIMS

Fatigue, a distressing symptom in patients with heart failure (HF), is associated with progress and health outcomes. Fatigue has been identified as having multidimensions, but a few studies have used a multidimensional fatigue scale. Many factors related to HF, including physical, psychological, and situational factors, may impact fatigue. However, there is limited knowledge about how these HF-related factors are associated with multidimensional fatigue in outpatients with HF in Japan. The aim of this study was to identify HF-related factors [physical; clinical characteristics, New York Heart Association (NYHA) functional class and physical function, psychological; depressive symptoms and anxiety, situational; health literacy and perceived control] associated with the five dimensions of fatigue in outpatients with HF.

METHODS AND RESULTS

Outpatients with HF (N = 165, mean age = 69.5 years, 78.8% male) completed the survey and physical assessment of gait speed. Fatigue was assessed using five dimensions of the Multidimensional Fatigue Inventory-20. Multiple linear regression analysis was conducted for each dimension of fatigue. General fatigue was predicted by age, NYHA, and perceived control. Physical fatigue was predicted by NYHA, depressive symptoms, and perceived control. Reduced activity was predicted by NYHA, gait speed, depressive symptoms, communicative health literacy, and critical health literacy. The reduced motivation was predicted by depressive symptoms and perceived control. Mental fatigue was predicted by depressive symptoms.

CONCLUSION

Different factors were significantly associated with each fatigue dimension. Further research is needed to alleviate fatigue in patients with HF.

Prevalence, correlates, and network analysis of depression and its association with quality of life in survivors with myocardial infarction during the COVID-19 pandemic

BACKGROUND

Depression is common among myocardial infarction (MI) survivors and is strongly associated with poor quality of life (QOL). The aim of this study was to examine the prevalence, correlates and the network structure of depression, and its association with QOL in MI survivors during the COVID-19 pandemic.

METHODS

This cross-sectional study evaluated depression and QOL in MI survivors with the Chinese version of the nine-item Patient Health Questionnaire (PHQ-9) and World Health Organization Quality of Life-BREF (WHOQOL-BREF) respectively. Univariable analyses, multivariable analyses, and network analyses were performed.

RESULTS

The prevalence of depression (PHQ-9 total score ≥ 5) among 565 MI survivors during the COVID-19 pandemic was 38.1 % (95 % CI: 34.1-42.1 %), which was significantly associated with poor QOL. Patients with depression were less likely to consult a doctor regularly after discharge, and more likely to experience more severe anxiety symptoms and fatigue. Item PHQ4 "Fatigue" was the most central symptom in the network, followed by PHQ6 "Guilt" and PHQ2 "Sad mood". The flow network showed that PHQ4 "Fatigue" had the highest negative association with QOL.

CONCLUSION

Depression was prevalent among MI survivors during the COVID-19 pandemic and was significantly associated with poor QOL. Those who failed to consult a doctor regularly after discharge or reported severe anxiety symptoms and fatigue should be screened for depression. Effective interventions for MI survivors targeting central symptoms, especially fatigue, are needed to reduce the negative impact of depression and improve QOL.

A qualitative enquiry regarding the factors influencing return to work after a cardiac incident in the Western Cape, South Africa

BACKGROUND

Cardiovascular disease is amongst the top three leading causes of mortality in South Africa and the world. The effects of cardiovascular disease can be seen in limitations of function within all spheres of life, including work function. Cardiac rehabilitation programs have been documented to improve functional abilities, however further research is required with regard to activity limitation, participation restrictions, facilitators, and barriers of return to work, after cardiac rehabilitation.

OBJECTIVE

This qualitative study aimed to determine and explore the barriers and enablers of return to work for individuals with cardiovascular disease who completed a cardiac rehabilitation program in the Western Cape, South Africa. The qualitative exploration was part of a study that resulted in a return-to-work program for individuals with cardiac disease.

METHOD

Qualitative methodology was employed for this study. Semi-structured interviews were used with 10 participants that attended a cardiac rehabilitation program. Thematic analysis of the qualitative data was completed.

RESULTS

The participants described the barriers and facilitators of their return-to-work process and the factors that were of critical importance in the resumption of the worker role or the result of unemployment. The four major themes were 1) Cardiac conditions negatively affect function, 2) Being unemployed, 3) Participation in ADLs and lifestyle modification enhances one's activity levels, and 4) Return to work.

CONCLUSION

Lifestyle modification and reasonable accommodation enable a successful return to work after a cardiac incident.

Cortisol response to psychosocial stress, mental distress, fatigue and quality of life in coronary artery disease patients

We aimed to explore the relationship between cortisol response to psychosocial stress, mental distress, fatigue and health related quality of life (HRQoL) in individuals with coronary artery disease (CAD) after recent acute coronary syndrome (ACS). A cross-sectional study initially included 113 subjects (88% men, 53 ± 7 years) 1-3 weeks after ACS. Cortisol response was assessed by measuring salivary cortisol during Trier Social Stress Test. Mental distress was measured with Hospital Anxiety and Depression Scale, State-Trait Anxiety Inventory, and Type D Scale-14. Fatigue symptoms were evaluated using Multidimensional Fatigue Inventory 20-items, while HRQoL was assessed with 36-Item Short Form Medical Outcome Questionnaire. After conducting multivariable linear regression analyses, diminished cortisol response sampled after Public speech (T3-T1, + 15 min) was significantly associated with higher anxiety symptoms (β = -0.224; p = 0.035), while diminished cortisol response sampled after preparation time (T2-T1, + 10 min) was significantly linked with the presence of Type D personality (β = -0.290; p = 0.006; β = -0.282; p = 0.008 respectively), even after controlling for confounders (i.e., sex, age, education, New York Heart Association functional class, beta-blockers and baseline levels of cortisol measures). We found that mental distress, but not fatigue and HRQoL, was linked with blunted cortisol response during anticipation time of psychosocial stress, independently of potential covariates.

The Interactive Effects of Post-Traumatic Stress Symptoms and Breathlessness on Fatigue Severity in Post-COVID-19 Syndrome

Background: Post-traumatic stress symptoms (PTSS) and breathlessness have been well documented in the acute phase of COVID-19 as well as in Post-COVID-19 Syndrome (PCS), commonly known as Long-COVID. The present study aimed to explore whether PTSS and breathlessness interact to exacerbate fatigue among individuals recovering from PCS, similar to the effects evidenced in other health conditions that feature respiratory distress.. Methods: Outcome measures were collected from 154 participants reporting persistent fatigue following acute COVID-19 infection who were enrolled in a 7-week rehabilitation course provided by the Primary Care Wellbeing Service (PCWBS) in Bradford District Care NHS Foundation Trust (BDCFT). Results: Hierarchical multiple linear regression revealed that fatigue severity was associated with a significant interaction between PTSS and breathlessness, even when controlling for pre-COVID health related quality of life (HRQoL), age, symptom duration and hospital admittance during the acute phase. Furthermore, improvements in fatigue following rehabilitation were significantly associated with improvements in PTSS. Conclusions: PTSS may be an important therapeutic target in multidisciplinary rehabilitation for reducing fatigue in the recovery from PCS. It is therefore important that treatment for PCS takes a biopsychosocial approach to recovery, putting emphasis on direct and indirect psychological factors which may facilitate or disrupt physical recovery. This highlights the need for all PCS clinics to screen for PTSD and if present, target as a priority in treatment to maximise the potential for successful rehabilitation.

Factors Associated With Myocardial Infarction Reoccurrence

BACKGROUND

As recurrent myocardial infarctions (MIRs) constitute almost a third of the annual incidence of myocardial infarction, identifying the traditional and novel variables related to MIR is important.

OBJECTIVE

The aim of this study was to examine modifiable cardiac risks, adiposity, symptoms associated with inflammation (fatigue, depression, sleep) and inflammatory cytokines, and MIR by sex and race.

METHODS

Using a cross-sectional descriptive design, we recruited a convenience sample of adults (N = 156) discharged with first myocardial infarction or had MIR in the last 3 to 7 years. Surveys measured demographics, cardiac risk factors, depression, sleep, and fatigue. Anthropometric measures and cytokines tumor necrosis factor-α, interleukin-6, and high-sensitivity C-reactive protein (hsCRP) were obtained. A maximum likelihood regression was calculated to predict MIR.

RESULTS

The sample included 57% male and 30% Black participants, and the mean (SD) age was 65 (12) years. The hsCRP was the only cytokine related to symptoms: fatigue ( r = 0.309, P < .001) and depression ( r = 0.255, P = .002). An MIR was not associated with race despite White participants reporting better sleep ( t146 = -3.25, P = .002), lower body mass index ( t154 = -3.49, P = .001), and fewer modifiable risk factors ( t152 = -2.05, P = .04). An MIR was associated with being male, higher hsCRP and tumor necrosis factor-α levels ( P < .001), and higher inflammatory symptoms of fatigue ( P = .04), depression ( P = .01), and poor sleep ( P < .001).

CONCLUSION

Further examination of biomarkers to understand the mechanisms associated with inflammatory symptoms of fatigue, depression, and poor sleep and MIR is needed.

Sleep disturbance after acute coronary syndrome: A longitudinal study over 12 months

Background

Sleep disturbance has been associated with poor prognosis in patients with acute coronary syndrome (ACS). This study examined the course of sleep disturbance and associated factors in patients with ACS who were followed for one year.

Methods

Study participants were 180 patients (mean age 59.6 years, 81.7% men) with ACS admitted to a tertiary hospital to undergo acute coronary intervention. Sleep disturbance was interviewer-assessed at admission (n = 180), at 3 months (n = 146), and at 12 months (n = 101) using the Jenkins Sleep Scale (JSS)-4, with a total of 414 assessments over one year. Random linear mixed regression models were used to evaluate the relationship between sociodemographic factors, cardiac diseases severity, perceived distress during ACS, comorbidities, medication, health behaviors, and sleep disturbance over time.

Results

At admission, 3 months, and 12 months, 56.7%, 49.3%, and 49.5% of patients, respectively, scored above the mean value for sleep disturbance in the general population (JSS-4 score ≥5). There was a significant decrease in continuous JSS-4 scores over time [estimate (SE) = -0.211 (0.074), p = 0.005]. Female sex [0.526 (0.206), p = 0.012], greater fear of dying [0.074 (0.026), p = 0.004], helplessness during ACS [0.062 (0.029), p = 0.034], and a history of depression [0.422 (0.171), p = 0.015] were independently associated with higher JSS-4 scores over time.

Conclusion

Despite a decrease from admission to 3 months, sleep disturbance is prevalent in the first year after ACS. Female sex, depression history, and distress during ACS identify patients at increased risk of developing persistent sleep disturbance and may inform interventions to prevent sleep disturbance.

Powerful Stress Relieving Medicinal Plants for Anger, Anxiety, Depression, and Stress During Global Pandemic

Consideration and improvement for anxiety and depression are important during a global pandemic. Appropriate healthcare can be obtained by paying more attention to traditional medicinal sciences. The adverse effects of stress with various symptoms can be managed by introducing plants that boost mental health. The most relevant psychological reactions in the general population related to the global pandemic are pervasive anxiety, frustration and boredom, specific and uncontrolled fear, disabling loneliness, significant lifestyle changes, and psychiatric conditions. Ginseng, chamomile, passionflower, herbal tea, lavender, saffron, kava, rose, cardamom, Chinese date, and some chief formula like yokukansan, Dan-zhi-xiao-yao-san, so-ochim-tang-gamiband, and saikokaryukotsuboreito are notable herbal treatments for mental health problems. The most common medicinal plants that have been used in Iran for the cure of stress and anxiety are Viper's-buglosses, Dracocephalum, valerian, chamomile, common hop, hawthorns, and lavender. Medicinal plants and herbs can be used for the treatment and alleviation of the negative effects of stress, anger, and depression during the global pandemic.

Effect of a Recliner Chair with Rocking Motions on Sleep Efficiency

In this study, we analyze the effect of a recliner chair with rocking motions on sleep quality of naps using automated sleep scoring and spindle detection models. The quality of sleep corresponding to the two rocking motions was measured quantitatively and qualitatively. For the quantitative evaluation, we conducted a sleep parameter analysis based on the results of the estimated sleep stages obtained on the brainwave and spindle estimation, and a sleep survey assessment from the participants was analyzed for the qualitative evaluation. The analysis showed that sleep in the recliner chair with rocking motions positively increased the duration of the spindles and deep sleep stage, resulting in improved sleep quality.

Fatigue Is Associated With Diminished Cardiovascular Response to Anticipatory Stress in Patients With Coronary Artery Disease

Background

Fatigue and psychophysiological reactions to mental stress are known to be problematic in coronary artery disease (CAD) patients. Currently, studies exploring the relationship between fatigue and cardiovascular reactivity to stress are scarce and inconsistent. The current study aimed to investigate the links between cardiovascular response to mental stress and fatigue in CAD patients after acute coronary syndrome (ACS).

Methods

The cross-sectional study investigated 142 CAD patients (85% males, 52 ± 8 years) within 2-3 weeks after recent myocardial infarction or unstable angina pectoris. Fatigue symptoms were measured using Multidimensional Fatigue Inventory 20-items, while cardiovascular reactivity to stress [i.e., systolic (S) and diastolic (D) blood pressure (ΔBP), and heart rate (ΔHR)] was evaluated during Trier Social Stress Test (TSST). In addition, participants completed psychometric measures, including the Hospital Anxiety and Depression scale and the Type D Scale-14. Multivariable linear regression analyses were completed to evaluate associations between fatigue and cardiovascular response to TSST, while controlling for confounders.

Results

After controlling for baseline levels of cardiovascular measures, age, gender, education, heart failure severity, arterial hypertension, smoking history, use of nitrates, anxiety and depressive symptoms, Type D Personality, perceived task difficulty, and perceived task efforts, cardiovascular reactivity to anticipatory stress was inversely associated with both global fatigue (ΔHR: β = -0.238; p = 0.04) and mental fatigue (ΔSBP: β = -0.244; p = 0.04; ΔHR β = -0.303; p = 0.01) as well as total fatigue (ΔSBP: β = -0.331; p = 0.01; ΔHR: β = -0.324; p = 0.01).

Conclusion

In CAD patients after ACS, fatigue was linked with diminished cardiovascular function during anticipation of a mental stress challenge, even after inclusion of possible confounders. Further similar studies exploring other psychophysiological stress responses are warranted.

Diagnostic accuracy and suitability of instruments that screen for obstructive sleep apnoea, insomnia and sleep quality in cardiac patients: a meta-analysis

BACKGROUND

A number of clinical guidelines recommend that all cardiac rehabilitation patients should be screened for potential sleep disorders with a validated screening instrument. There is currently no consensus on what specific tools should be used.

OBJECTIVE

To identify tools that are practical to use in the clinical environment and have high diagnostic accuracy.

METHODS

We systematically searched online databases to identify patient reported outcome instruments that have been used in published research studies to assess the likelihood of obstructive sleep apnoea (OSA) in cardiac patients. In studies that provided diagnostic data, these data were extracted and verified via an evidence-based diagnostic calculator. Where sufficient numbers of studies were available, a meta-analysis was conducted to determine pooled estimates of specificity, sensitivity and diagnostic odds ratios. Selected papers were qualitatively assessed using the Standards for Reporting Diagnostic accuracy studies (STARD).

RESULTS

Of the 21 instruments identified, six detected likelihood of OSA, two assessed daytime sleepiness, five assessed insomnia and eight examined sleep quality. A meta-analysis of 14 studies that assessed diagnostic accuracy of moderate OSA, revealed moderate sensitivity for the Berlin Questionnaire, Sens = 0.49 (95% CI 0.45-0.52) and good sensitivity for the Stop-BANG, Sens = 0.93 (95% CI 0.87-0.96) but poor specificity at standard cut-off criteria.

CONCLUSION

There are promising practical tools available to screen patients with OSA and other sleep disorders in cardiac rehabilitation settings, but specificity could be improved. Additional assessment of sleep quality may enhance prognostic ability with both OSA and insomnia screening.

Men's Positive and Negative Experiences Following Acute Myocardial Infarction

(1) Objective: To describe men's experiences as acute myocardial infarction sufferers from a social phenomenological perspective, a year after the event (2) Methods: The phenomenological interview was used to capture the participants' discourse. The data were analyzed according to the theoretical methodological approach of social phenomenology. (3) Results: The discourse analysis of the content produced the following categories, set out according reasons "why": personal biography, knowledge set, warning signs prior to the illness, experience at the intensive care unit, and rehabilitation process; and reasons "for": expectations as regards the illness, health professionals, and future social life and work prospects. (4) Conclusions: Participants had not established a healthy condition one year after myocardial infarction, perceiving a very thin line between life and death. Personal biography influences the coping of the disease. They feel like the illness helped them to create new meanings and value of life. They envisage a future full of great restrictions and uncertainty. The results of this study have underlined the need to involve care at all stages of the illness: the physical and emotional dependence upon admittance at the intensive care unit, the need to be cured, the constant demand for information about the illness, the difficulties encountered upon returning home, uncertainty about the future, etc. All these moments indicate that proper nursing care adapted to the specific needs of each individual and their family members must be provided in order to help them to overcome all the stages involved in this process. It is necessary to individualize care because the sense of reality is common and universal, but the ways of expressing are subjective, and it depended on the totality of experiences accumulated throughout life.

Traditional herbal medicines to overcome stress, anxiety and improve mental health in outbreaks of human coronaviruses

Mental health condition is including depression and anxiety, and they may impact wellbeing, personal relationships and productivity of both genders. Herbal medicines have been used to treatment of anxiety and depression symptoms for centuries. SARS, MERS and COVID-19 are related to coronavirus types. SARS (sever acute respiratory syndrome, China, 2002), MERS (Middle East respiratory syndrome, Saudi Arabia, 2012), and SARS-CoV-2 (2019-2020) are the main coronavirus outbreaks. Both anxiety and depression are more serious to be considered and improved for all general public during fight with these diseases. In this mini-review article, we have mentioned the key role some of the most important plants and herbs for treatment of stress and anxiety and improve mental health against SARS and SARS-CoV-2 on the basis of traditional Asian medicine, especially traditional Chinese and Persian medicine.

Patient-reported experience and outcome measures during treatment for gastroesophageal cancer

OBJECTIVE

Gastroesophageal cancer has high mortality, and continuous assessment of patient-reported data is salient for optimisation of supportive care. We aimed to evaluate our multidisciplinary concept with respect to patient-reported variables.

METHODS

At diagnosis and later during the treatment, three areas of patient-reported measures were evaluated: the given information and care, fatigue (Multidimensional Fatigue Inventory [MFI-20]), dysphagia (Ogilvie dysphagia score) and weight loss.

RESULTS

Of 130 outpatients, planned for a surgical procedure and given a contact nurse (CN), 106 responded. During treatment, 81% of the patients were satisfied with their CN. The given information was considered very good or good by >90% and easily understood. Half of the patients reported need for supportive care, which was rated good by 85%. All dimensions of the MFI-20 test, except mental fatigue, worsened during the treatment period. At diagnosis, 61% of the patients experienced eating problems, leading to 7% weight loss. Although dysphagia improved, weight loss reached 13% at the end of treatment.

CONCLUSION

A multidisciplinary concept can be of value in giving appropriate and understandable information, leading to high satisfaction with the provided care. However, as fatigue and weight loss increased during the treatment period, patients need structured multidisciplinary support.

Reliability and viability of using the Multidimensional Fatigue Inventory-20 in patients with chronic coronary artery disease

OBJECTIVE

To verify the reliability and viability estimates of using the translated and adapted version of the Multidimensional Fatigue Inventory-20 for use in Brazil in patients with chronic coronary artery disease.

METHOD

A methodological study. The instrument was answered by the participants without the help of the researchers. Filling time was recorded, and facilities and difficulties were documented. The viability of use was analyzed through acceptability, practicality, ceiling and floor effects. Reliability was estimated by internal consistency.

RESULTS

The sample consisted of 201 participants. The mean fatigue score was 51.9 + 14.0. There was a small rate of unanswered items (0.65%), although 30.3% of participants requested some clarification after reading the instructions; 37.3% reported that they had doubts when answering the items, especially number 19. The response time was 4.8 + 1.9 minutes. There were no ceiling or floor effects. The reliability estimate was adequate.

CONCLUSION

The instrument needs adjustments to the wording of the instructions and some items, although it has good acceptability and reliability estimates.

Enhancing Parental Coping with a Child's Heart Condition: A Co-production Pilot Study

Families of children with congenital heart disease (CHD) can have difficulties coping with the stress of their child's condition and would benefit from assistance to cope better. To address the needs of these parents, the Australian Center for Heart Health/HeartKids Australia/Melbourne Graduate School of Education co-produced Family Coping Project was initiated. This project involved two systematic literature reviews, interviews with parents of children with CHD, and the development and piloting of a manualised parental coping program. The primary aims of the pilot study were to determine whether the program would: attract high needs families; enhance the coping self-efficacy of parents; and be acceptable to parents in terms of content and mode of delivery. The secondary aims were to investigate whether the program would impact on parental coping, parental stress and general stress. Parents completed pre-, post-program and 6-month follow up assessment measures, with parent stress scores being compared to stress scores reported for other chronic condition parent carer groups. Twenty-one parents participated and provided baseline data. They were found to be significantly more stressed than other parent carer groups. Eleven parents completed post-program data and 13 completed 6-month follow-up data. There was a significant increase in parents' coping self-efficacy from pre- to post-program, and from pre- to 6-months. Parents' use of productive coping styles increased significantly from pre- to post-program. The program was rated as highly acceptable in terms of content and delivery mode. The pilot provides strong evidence for upscaling the program in conjunction with individualized psychological support for parents to extend knowledge acquisition and attitude change into enhanced coping skills and demonstrated the benefits of a co-production process.

Illness perception and high readmission health outcomes

This review identified associations between illness perception and health outcomes of patients with a medical diagnosis included in the Hospital Readmissions Reduction Program. Inclusion criteria were English language, use of quantitative methodology, health outcomes specified, and identifiable effect size and statistical significance of the relationship. Most of the 31 studies in this review showed that favorable illness perception has been associated with better health outcomes, while unfavorable illness perception has been associated with worse outcomes. A multifaceted approach might include behavioral, clinical, educational, and psychosocial components to improve one’s illness perception through educative, cognitive-behavioral, or psychodynamic counseling.

Sleep Disturbances in Patients With Coronary Heart Disease: A Systematic Review

STUDY OBJECTIVES

Investigation into sleep and coronary heart disease (CHD) has predominantly been focused on sleep disturbances as a risk factor for developing CHD. Objectively measured and self-reported sleep at a patient level has only been sparsely and not systematically reported. Therefore, we set out to review the literature for studies using objectively measured and self-reported sleep in patients with CHD. The review focuses on patients with acute coronary syndrome (ACS) and stable CHD.

METHODS

A systematic review performed in four databases adhering to the PRISMA guidelines applying a qualitative synthesis of evidence.

RESULTS

Following ACS, we found sleep architecture to be significantly disturbed with changes normalizing over a period of up to 6 months. With increasing severity of CHD, sleep disturbances were more pronounced; however, the modulating effects of sleep-disordered breathing and ejection fraction on sleep in patients with CHD are conflicting. Overall, studies were predominantly cross-sectional in design and of low methodological quality. Polysomnography was the predominant outcome assessment tool and validated self-reported assessment tools were limited.

CONCLUSIONS

Future investigations in sleep and CHD applying both a longitudinal design and investigating objective and self-reported sleep assessments are warranted.

SYSTEMATIC REVIEW REGISTRATION

Registry: PROSPERO, Title: Sleep measures in relation to coronary heart disease: a systematic review, Identifier: CRD42017056377, URL: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=56377.

Fatigue and acute coronary syndrome: a systematic review of contributing factors

Fatigue is a symptom of ACS, but it remains unclear who is at risk and what factors contribute to fatigue. The purpose of the systematic review was to identify factors that influence fatigue in patients with ACS. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Literature published from 1981 to 2017 was reviewed, and of 983 articles screened, 36 met inclusion criteria. Variables contributing to fatigue fell into 3 categories: demographic characteristics, clinical characteristics, and other factors. More fatigue was found in women than men, and significant differences in fatigue were identified by race. Additionally, sleep deprivation, depression, and anxiety were associated with higher levels of fatigue. The findings highlight the importance of demographic, clinical, and other factors' impact on fatigue in ACS patients. Fatigue is an important symptom in ACS and healthcare providers must recognize how patient variables affect symptom expression.