Coping and emotional well-being in patients with chronic heart failure

Background: Chronic heart failure (CHF) is a serious illness, with a profound impact on the patient. Poor health-related quality of life (HRQoL) as well as anxiety and depression are prevalent in CHF and predict mortality and rehospitalization, yet, psychosocial factors are infrequently treated and cared for.

Aim: To gather scientific evidence on illness perception and coping strategies to predict emotional well-being in patients with CHF and to establish a measurement model of coping strategies. Furthermore, to evaluate a nurse-led psychoeducational intervention, Coping Effectiveness Training (CET) adapted for patients with CHF.

Methods: Studies I-III were cross sectional. Study IV was a randomized controlled trial aimed to improve emotional well-being (one-year follow-up). All studies used patient reported outcome measures and clinical data via medical journals.

Results: Younger age and male gender were associated with higher levels of alcohol usage and/or drugs to cope, p < 0.01. Poor sense of coherence was associated with maladaptive coping (I). A four factorial model of Brief COPE displayed the best psychometric properties (II). Avoidant coping influenced negative affect (NA) (I), worse HRQoL (II) and greater anxiety and depression (III). CET (IV) improved personal control in the intervention group (IG) compared to the control group (CG), p = 0.036. Improved scores for the IG were detected in emotional well-being and HRQoL, p = ns. The IG demonstrated reduced NA, p = 0.022, excluding cases with clinical anxiety and depression. Time to cardiovascular readmission or death was non-significantly lower in the IG vs the CG (Hazard ratio 0.58 [0.29-1.18]) adjusted p = 0.135.

Conclusions: Personal resources seemed to influence the coping strategies used by patients with CHF. Avoidant coping had an adverse influence on emotional well- being and illness perception in CHF. The perceived sense of control and illness burden were of importance for emotional well-being. A CET intervention for patients with CHF increased sense of control over the illness. CET also reduced NA in patients with no or mild symptoms of anxiety and depression.

List of scientific papers

I. Nahlén C., Saboonchi F. Coping, sense of coherence and the dimensions of affect in patients with chronic heart failure. European Journal of Cardiovascular Nursing, 2010; 9(2), 118-125.
https://doi.org/10.1016/j.ejcnurse.2009.11.006

II. Nahlén Bose C., Björling G., Elfström M. L., Persson H., Saboonchi F. Assessment of coping strategies and their associations with health related quality of life in patients with chronic heart failure: the Brief COPE restructured. Cardiology Research, 2015; 6(2), 239-248.
https://doi.org/10.14740/cr385w

III. Nahlén Bose C., Elfström M. L., Björling G., Persson H., Saboonchi F. Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failure. [Manuscript]

IV. Nahlén Bose C., Persson H., Björling G., Ljunggren G., Elfström M. L., Saboonchi F. Evaluation of a Coping Effectiveness Training intervention in patients with chronic heart failure – a randomized controlled trial. [Manuscript]