Stress, cognitive appraisal, coping, and event free survival in patients with heart failure

Objectives To describe self-reported stress level, cognitive appraisal and coping among patients with heart failure (HF), and to examine the association of cognitive appraisal and coping strategies with event-free survival. Methods This was a prospective, longitudinal, descriptive study of patients with chronic HF. Assessment of stress, cognitive appraisal, and coping was performed using Perceived Stress Scale, Cognitive Appraisal Health Scale, and Brief COPE scale, respectively. The event-free survival was defined as cardiac rehospitalization and all-cause death. Results A total of 88 HF patients (mean age 58 ± 13 years and 53.4% male) participated. Linear and cox regression showed that harm/loss cognitive appraisal was associated with avoidant emotional coping (β = -0.28; 95% CI: -0.21 – 0.02; p = 0.02) and event free survival (HR = 0.53; 95% CI: 0.28 – 1.02; p = 0.05). Conclusions The cognitive appraisal of the stressors related to HF may lead to negative coping strategies that are associated with worse event-free survival.