{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T05:46:49Z","timestamp":1792129609861,"version":"4.4.0"},"reference-count":82,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Advanced Nursing"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To synthesise evidence from systematic reviews on triggers and modifiers of acute coronary events to identify clinical implications. Triggers refer to transient exposures that may precipitate acute coronary events through several potential biological and haemodynamic mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>An umbrella review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, Web of Science, Epistemonikos, and Google Scholar were searched in May 2024, and an updated search was conducted in February 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This umbrella review was conducted following Joanna Briggs Institute (JBI) methodological guidance. Systematic reviews assessing short\u2010term or acute triggers and acute coronary events, including acute coronary syndrome, myocardial infarction, coronary occlusion, or spontaneous coronary artery dissection, and published in English were included. The quality of included reviews was evaluated using the JBI critical appraisal instrument.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010four systematic reviews examining 11 acute coronary event triggers were included. The most frequently reported triggers were air pollution (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098 reviews), respiratory infection (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096), and physical exertion (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20094). The hazard period was primarily 0\u20132\u2009h for physical exertion, sexual activity, and emotional stress, while environmental and infection\u2010related triggers extended to 7\u2009days for air pollution, up to 20\u2009days for heat exposure, and 28\u2009days for respiratory infections. Population\u2010attributable fractions were reported for physical exertion (10.6%), emotional stress (3.9%), and anger (3%). Potential modifiers of risk identified, such as regular physical activity, beta\u2010blocker use, and influenza vaccination, highlight opportunities for personalised prevention strategies to reduce risk when exposed to potential triggers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings highlight the role of triggers in acute coronary events. Future research should prioritise translating these insights into clinical nursing practice to mitigate acute event risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>Awareness of trigger\u2010specific risks can guide nurses to deliver targeted patient education, conduct precise risk assessments, and implement exposure\u2010management strategies, particularly for individuals at elevated cardiovascular risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  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