From Surviving to Thriving: ACS Survivors' Experiences in Lifestyle Transformation to Prevent Recurrence-A Qualitative Study

The recurrence of acute coronary syndrome (ACS) can be reduced through healthy lifestyle modification; however, many survivors struggle to sustain behavioral changes after hospital discharge. Previous studies have primarily focused on biomedical and behavioral outcomes, with limited attention to the psychosocial, emotional, and cultural processes involved in long-term recovery. This study explored the lived experiences of ACS survivors as they adapted to lifestyle changes within their social and cultural contexts. Data were collected through in-depth interviews with 15 ACS survivors between three months and one year after the cardiac event and analyzed using qualitative content analysis. Three interconnected themes emerged: (1) creating new habits, (2) reconciling with the situation, and (3) the dual role of family. Lifestyle modification was experienced as a continuous struggle involving deeply rooted habits, emotional dependence, declining motivation, and the process of self-acceptance in seeking inner peace. Some participants gradually developed self-regulation and adaptive coping strategies, whereas others remained trapped in smoking behaviors, emotional distress, and hopelessness. Participants perceived psychosocial support from healthcare professionals as limited and expressed a need for greater emotional reassurance and coping assistance. Psychospiritual adaptation was shaped by the Javanese values of nrimo and ikhlas. These values helped participants accept physical limitations, reduce fear, and reconstruct meaning after illness. Family relationships served both as sources of support and stress, while patriarchal family dynamics sometimes hindered open communication. These findings suggest that recovery after ACS involves identity reconstruction, emotional regulation, and culturally embedded coping processes that extend beyond medical adherence alone.