Coping styles associated with heart failure outcomes: A systematic review

Background: The incidence of heart failure continues to rise in the United States, with more than 600,000 new cases diagnosed each year. The progressive nature of heart failure predisposes individuals to physical and psychological sequelae, including physical activity intolerance and depressive symptoms. Coping is beneficial in assisting individuals to live with heart failure. Evidence suggests that how individuals cope with heart failure may influence heart failure-related outcomes, such as psychological well-being, self-care, health-related quality of life, and mortality. Thus, a better under- standing of coping styles can assist clinicians and researchers to develop interventions that improve heart failure outcomes. Purpose: To provide a systematic review and synthesis of evidence regarding the influence of coping styles in HF. A conceptualization of coping commonly used in heart failure-related literature within the context of stress and cognitive appraisal of stress is described. In addition, this review will identify what is known about: (1) individual factors that influence coping styles in heart failure; (2) the influence of coping styles on heart failure-related outcomes; and (3) interventions that promote effective (e.g., problem-focused) coping in heart failure. Methodological issues associated with this empirical literature and implications for clinicians and research also were discussed. Methods: This article provides a systematic review of current empirical evidence regarding the influence of coping styles on heart failure-related outcomes. Results: This review of empirical literature revealed several factors that may influence coping style in individuals with HF, including co-morbidities, personality, illness knowledge and beliefs, and sense of coherence. Additionally, the use of problem-focused coping strategies was found to be related to positive HF outcomes, such as psychological well-being, enhanced self-care, and improved health-related quality of life. Whereas, the use of emotion-focused coping strategies was found to be associated with negative HF outcomes, such as psychological distress, decreased health-related quality of life, and increased HF-related mortality. Although limited, experimental work in this area suggests that problem-focused coping strategies may be beneficial in improving HF-related outcomes. Conclusions: Effective coping aids the successful management of heart failure, specifically the management of associated physical symptoms and psychological sequelae that may result. Problem-focused strategies may be more beneficial than emotion-focused strategies in assisting individuals to cope with heart failure and improve heart failure outcomes, such as psychological well-being, self-care, and health-related quality of life. Conversely, emotion-focused strategies may nega- tively influence heart failure outcomes, such as psychological distress, decreased health-related quality of life, and heart failure-related mortality. Therefore, nurses should include problem-focused coping strategies in patient and family education. Research on the effectiveness of problem-focused strategies is sparse, thus more experimental studies, particularly longitudinal designs, is warranted to determine the efficacy of problem-focused interventions throughout the progression of heart failure.