Determinants of Health-Related Quality of Life After Acute Coronary Syndromes: A Systematic Review

Background/Objectives: Rapid advancements in reperfusion strategies and optimized medical therapies have significantly improved survival among patients with acute coronary syndromes (ACS). However, a large population still lives with the chronic consequences of the disease, including impaired post-discharge health-related quality of life (HRQOL). This systematic review aimed to identify and summarize the existing evidence regarding the determinants of HRQOL among patients with ACS. Methods: A comprehensive search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed in PubMed, Scopus, Web of Science and Science Direct until 20 July 2025. The review protocol was registered with PROSPERO (ID CRD420251157478). Results: From an initial 12,280 articles, 55 were selected. Forty-two studies used a cohort design and thirteen were cross-sectional. All studies were published between 2000 and 2025. Most of the studies were conducted in Europe and America. Common predictors of improved HRQOL were better baseline quality of life, previous exercise behavior, sense of coherence, coping strategies, revascularization during index hospitalization, time passed after ACS and diagnosis of STEMI. The most common factors that worsened HRQOL were female sex, lower educational and financial status, being unemployed, depression, anxiety, the presence of comorbidities and lower social support including having no partner. Conclusions: The findings highlight that post-ACS HRQOL is determined by multiple factors including demographic, clinical and psychological factors. Clinical practice should therefore focus on targeted strategies that optimize modifiable factors, prioritizing early psychological screening and individualized support for high-risk groups, to effectively improve HRQOL and overall quality of care.