Iran Journal of Nursing

Introduction
Due to the dangerous nature of cardiovascular diseases and their chronicity, these diseases are considered a crisis in the patient’s life and in addition to physical problems, also severely affect the psychological state of patients. It is essential to pay attention to the psychological complications after a heart attack in line with other physiological complications. The proximity of these patients to death has caused death anxiety, which can weaken their morale. This study aims to determine death anxiety and demoralization in patients with acute myocardial infarction admitted to post-cardiac care units of the Iran University of Medical Sciences in 2021.
Methods
The present study is a descriptive cross-sectional study that was conducted on 206 patients with myocardial infarction admitted to the educational-medical centers of the Iran University of Medical Sciences in the first half of 2021. The inclusion criteria included the definitive diagnosis of acute myocardial infarction, no death of first-degree relatives in the last 6 months, no alcohol and drug addiction according to the patient’s report, no surgery in the last 6 months, stable vital signs, and stable cardiac hemodynamics condition. The exclusion criteria included incomplete completion of questionnaires. Data collection tools included the demographic profile form, Templer death anxiety questionnaire, and Kissane demoralization. Sampling was continuous and myocardial infarction patients who were on the same-day discharge list were selected and completed the questionnaires. Due to the sensitivity of the issue, people who had high anxiety and low mood based on the cutting point of the tool while informing the responsible nurse, telephone psychological counseling was performed for them and if the client wishes by the researcher. After completion, questionnaires were collected and analyzed. Data analysis using SPSS software version 19 in two sections of descriptive statistics (frequency, percentage, Mean±SD) and inferential statistics (Pearson correlation coefficient, independent t test, and analysis of variance), and a significance level of less than 0.05 0 was considered.
Results
In this study, 207 patients with myocardial infarction participated and one person was excluded from the study due to the incompleteness of the questionnaire. A total of 72.8% of patients were male with a mean age of 57.97±12.49 years, 92.7% were married and 34.5% were self-employed. 35.9% had a history of hypertension and 24.3% had a history of diabetes; 90.8% of patients had insurance and 81.6% had a history of previous hospitalization. The mean score of death anxiety in patients with myocardial infarction was 6.26±1.62 (moderate). Most patients (43.7%) had moderate death anxiety. The mean score of demoralization syndrome was 11.88±5.34 (severe). Most patients (60.7%) had severe demoralization syndrome.
Conclusion
In response to the research questions, the findings indicated that the rate of death anxiety in patients with myocardial infarction was moderate and the rate of depressive symptoms was high. Due to the nature of heart disease and the destructive nature of both complications of death anxiety and low mood syndrome, it is necessary to plan to reduce these complications as soon as possible. Obtain psychological information and use nursing interventions. Also, in response to research questions, the results showed that some demographic factors, such as age and education and some disease characteristics, such as the duration of previous hospitalization and co-morbidity with other diseases can predict death anxiety and mood swings in these patients should be involved, therefore for higher effectiveness, it is recommended to identify and pay attention to these factors in planning and interventions.

Ethical Considerations
Compliance with ethical guidelines
To comply with the ethics in the research, while receiving the code of ethics (IR.IUMS.REC.1400.450) from the Ethics Committee of the Iran University of Medical Sciences, the patients were reminded that participation in the study is completely optional and non-participation does not affect their treatment process, it is not necessary to mention the names and last name, and the information remains completely confidential.

Funding
This study was extracted from the master thesis of Soheila Rahimi, approved by the Iran University of Medical Sciences.

Authors' contributions
Conceptualization and project administration: Soheila Rahimi and Mehrnoosh Inanlou. Research and review: Mehrnoosh Inanlo and Tahereh Najafi Qazaljeh. Data analysis: Hamid Haqqani. Editing and revision: Mehrnoosh Inanlo.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
We are extremely grateful to the post-graduate education department of Iran University of Medical Sciences and Health Services and the cooperation of the officials and respected patients without whose cooperation this research would not have been possible.

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