Coping styles as predictors for quality of life and prognosis in patients at risk for or with a diagnosis of heart failure: Results from the observational DIAST-CHF study

Abstract

Objective: Patients with heart failure often experience impaired health-related quality of life (HRQOL) and have an increased risk of cardiovascular and cerebrovascular events. The aim of this study was to investigate the predictive role of different coping styles on outcome.

Methods: This longitudinal study included 1536 participants who either had cardiovascular risk factors or were diagnosed with heart failure. Follow-ups took place one, two, five and ten years after recruitment. Coping and HRQOL were investigated using self-assessment questionnaires (Freiburg Questionnaire for Coping with Illness, Short Form-36 Health Survey). Somatic outcome was quantified by incidence of major adverse cardiac and cerebrovascular events (MACCE) and 6-min-walking-distance.

Results: Pearson correlation and multiple linear regression analysis showed significant associations between the coping styles used at the first three time points and HRQOL after five years. After adjusting for baseline HRQOL, minimization and wishful thinking predicted worse mental HRQOL (β = -0.106; p = 0.006), while depressive coping predicted worse mental (β = -0.197; p < 0.001) and physical HRQOL (β = -0.085; p = 0.03; n = 613). Active problem-oriented coping could not significantly predict HRQOL. Only minimization and wishful thinking was significantly associated with an increased 10-year-risk for MACCE (hazard ratio = 1.06; 95% confidence interval: 1.01-1.11; p = 0.02; n = 1444) and reduction in 6-min-walking-distance at 5 years (β = -0.119; p = 0.004; n = 817) in adjusted analyses.

Conclusions: Depressive coping and minimization and wishful thinking were associated with worse quality of life in patients at risk for or with diagnosed heart failure. Minimization and wishful thinking also predicted worse somatic outcome. Therefore, patients using those coping styles might benefit from early psychosocial interventions.

Keywords: Cardiovascular risk factors; Chronic heart failure; Coping strategies; Event-free survival; Health-related quality of life; Somatic outcome.