Is coping style linked to emotional states in heart failure patients?

BACKGROUND: Negative emotional states such as anxiety and depression are associated with increased mortality and morbidity in cardiac patients. Clinicians who counsel patients with heart disease often focus on enhancing coping skills to reduce negative emotions. METHODS: To identify the relationship between 3 coping styles (active behavioral, active cognitive, and avoidance) and emotional states, we studied 84 advanced heart failure patients and used the Dealing with Illness-R Checklist to measure coping and the Profile of Mood States to measure emotional distress. RESULTS: Patients who reported greater use of active behavioral coping demonstrated less fatigue and more vigor than patients who reported lower use of that coping style. When demographic and clinical variables were taken into account, the avoidance coping style was associated with significantly higher anxiety, anger, depression, confusion, and fatigue in patients with advanced heart failure. CONCLUSIONS: Incorporating interventions that support active behavioral coping in lieu of avoidance coping may improve the emotional well-being of patients with heart failure.

Sleep disturbance symptoms in patients with heart failure.

Sleep disturbances have a major impact on physical functioning, emotional well-being, and quality of life, but are not well described in patients with heart failure (HF). Eighty-four HF patients completed a sleep survey and provided demographic and clinical data. Seventy percent of the patients were male with a mean age of 54 years and a mean left ventricular ejection fraction of 22%. Forty-seven patients (56%) reported trouble sleeping and one-third used sleeping medication. The most frequently reported problems were inability to sleep flat (51%), restless sleep (44%), trouble falling asleep (40%), and awakening early (39%). Using logistic regression, physiological variables were tested as predictors of sleep disturbance. Severity of HF, age, gender, etiology, obesity, smoking, and use of beta-blockers were not predictors of sleep disturbance. HF patients experience significant sleep disturbances, which are not predicted by severity of symptoms or clinical status. Problems with sleep are an important component of a clinical assessment in this vulnerable population.

Perceived control reduces emotional stress in patients with heart failure.

We studied patients with heart failure (HF) to determine if perceived control reduces emotional distress (i.e., anxiety, depression and hostility) in chronic, debilitating cardiac illness and whether the demographic, clinical and psychologic characteristics of patients with high and low perceived control differed. Psychological assessment of 222 patients with heart failure included an evaluation of perceived control using the Control Attitudes Scale, as well as anxiety, depression and hostility using the Multiple Affect Adjective Checklist. Using multivariate analysis to control for differences in demographic and clinical characteristics, we found that patients with high perceived control had significantly greater 6-minute walk distances and less emotional distress than patients with low perceived control. Interventions designed to increase perceived control may be an important aspect of HF care, but require testing in randomized trials.