UMMS Affiliation

Department of Population and Quantitative Health Sciences; Division of Cardiovascular Medicine, Department of Medicine

Publication Date


Document Type



Alternative and Complementary Medicine | Behavioral Medicine | Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Health Services Administration | Religion


BACKGROUND: Prior studies of healthy populations have found religious practices to be associated with survival. However, no contemporary studies have examined whether religiosity influences survival among patients discharged from the hospital after an acute coronary syndrome (ACS). The present study examined the relationship between religious practices and 2-year all-cause mortality among hospital survivors of an ACS.

METHODS: Patients hospitalized for an ACS were recruited from 6 medical centers in Massachusetts and Georgia between 2011 and 2013. Study participants self-reported three items assessing religiosity: strength/comfort from religion, petition prayers for health, and awareness of intercessory prayers by others. All cause-mortality within 2-years of hospital discharge was ascertained by review of medical records at participating study hospitals and from death certificates. Cox proportional hazards models were used to estimate the multivariable adjusted risk of 2-year all-cause mortality.

RESULTS: Participants (n = 2,068) were on average 61 years old, 34% were women, and 81% were non-Hispanic White. Approximately 85% derived strength/comfort from religion, 61% prayed for their health, and 89% were aware of intercessions. Overall, 6% died within 2 years post-discharge. After adjusting for sociodemographic variables (age, sex, and race/ethnicity), petition prayers were associated with an increased risk of 2-year all-cause mortality (HR: 1.64; 95% CI: 1.01-2.66). With further adjustment for several clinical and psychosocial measures, this association was no longer statistically significant. Strength and comfort from religion and intercessory prayers were not significantly associated with mortality.

CONCLUSIONS: Most ACS survivors acknowledge deriving strength and comfort from religion, praying for their health, and intercessions made by others for their health. Although the reported religious practices were not associated with post-discharge survival after multivariable adjustment, acknowledging that patients utilize their religious beliefs and practices as strategies to improve their health would ensure a more holistic approach to patient management and promote cultural competence in healthcare.


Religion, Behavioral and social aspects of health, Depression, Cognitive impairment, Patients, Health education and awareness, Death rates, Psychological stress

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This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

DOI of Published Version



PLoS One. 2019 Oct 4;14(10):e0223442. doi: 10.1371/journal.pone.0223442. eCollection 2019. Link to article on publisher's site

Journal/Book/Conference Title

PloS one

Related Resources

Link to Article in PubMed. Data Availability: The TRACE-CORE dataset used in our study are publicly available from the University of Massachusetts Medical School’s institutional repository, eScholarship@UMMS. The dataset can be accessed at either of the following links: or

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Creative Commons License
This work is licensed under a Creative Commons 1.0 Public Domain Dedication.