Chronic circulatory diseases are a major public health problem and the leading cause of death in Western countries (Higgins & Luepker, 1988; National Heart, Lung, and Blood Institute [NHLBI], 1994). Diseases of the circulatory system include acute rheumatic fever; chronic rheumatic heart diseases; hypertension; ischemic heart disease; pulmonary heart disease; cerebrovascular disease; diseases of the arteries, arterioles] and capillaries; and diseases of the veins, lymphatic vessels, and lymph nodes. Circulatory disorders have received increased attention in the public health arena because of their far-reaching impact and also because the occurrence of these disorders is intluenced by lifestyles and health habits. The limited success of some public health interventions to promote healthier lifestyles has led public health educators to turn to psychology for a better understanding of the principles of behavior change (Ewart, 1991). Despite the difficulties of implementing health behavior changes, lifestyle changes-when coupled with medical interventions-have led to a decline in circulatory disease-related mortality over the past 30 years (Higgins & Luepker, 1988; NHLBI, 1994). The circulatory diseases that have been most extensively studied by behavioral scientists-coronary heart disease (CHD) and essen-203

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The present study investigated: (1) mental and physical activities as possible triggers of implantable cardioverter defibrillator discharges; and (2) the temporal patterns of those di scharges in order to provide the rationale for a larger~sca le study.Retrospecti ve interviews of patients with coronary artery disease and implantable cardioverter defibrillators were conducted to determine frequency of discharges and timing of discharges as well as specific circumstances surrounding those discharges. The interview also collected information regarding the usual activity levels of the patients to serve as control or baseline data. The case-crossover method was used to approach the data of 32 patients who were interviewed. Over a two-year period, 20 of the 32 patients had experienced discharges. Elevated Mantel-Haenszel estimates of relative risk were found for high physical exertion, sexual activity, high mental activity, tension or stress, and anger, but these elevated risks were statistically non-significant given this small sample size. Chi-square analysis of a circadian pattern of discharges was statistically non-significant, but there was evidence of a seasonal variation in number of discharges ("t}= 9.00, p=O.029). This seasonal pattern revealed a peak prevalence of incidents during the winter months and a smaller peak during summer months.