1. College of Nursing ● University of Kentucky ● Lexington, KY
Stress, Cognitive Appraisal, Coping, and Event Free Survival in Heart Failure Patients
Abdullah S. Alhurani, PhDc, MSN, RN, Rebecca Dekker, PhD, RN, Elizabeth Tovar, PhD, RN, Alison Bailey, MD, Terry A. Lennie, PhD, RN, FAAN, David C. Randall, PhD, Debra K. Moser, DNSc, RN, FAAN
College of Nursing ● University of Kentucky ● Lexington, KY
Background
Although biological factors contribute to the high morbidity and mortality in heart failure (HF), there are many unexplored psychosocial factors that also likely contribute to poor prognosis such as stress, cognitive appraisal, and coping.
Objective
Based on the literature to date, a model of HF patients’ response to the stressor of HF is proposed (see Figure 1), and our objective was to test the relationships in this model.
Results
Linear and cox regression showed that harm loss cognitive appraisal was a significant predictor of avoidant emotional coping (β= -0.28; 95% CI: ; p= 0.02) and event free survival (HR= 0.53; 95% CI: ; p= 0.05). Finally avoidant emotional coping (HR= 3.23; 95% CI: ; p= 0.03) was a significant predictor of event free survival among HF patients in the unadjusted model. All other relations in the model were not significant.
Method
A total of 88 HF patients (mean age 58 ± years, 53.4% male, 54.5% NYHA II/IV) participated. Stress was measured using the brief Perceived Stress Scale, cognitive by the brief version of the Cognitive Appraisal Health Scale, and coping by the Brief COPE scale. Two tailed Pearson correlation was used to determine relationships among the variables. Cox regression analyses were used to determine if coping style or cognitive appraisal type predicted event-free survival. Linear and multiple regressions were used to determine the association of stress with coping style and cognitive appraisal type, and the association of cognitive appraisal type with coping style.
Discussion
Cognitive and behavioral therapy may be useful among HF patients who negatively appraise the stress of HF as such appraisal leads to negative coping strategies that are associated with worse event-free survival.
Results
Stress level was significantly associated with harm and loss cognitive appraisal (r= , p = 0.005) and avoidant emotional coping (r= , p = 0.005). Harm and loss cognitive appraisal was significantly associated with avoidant emotional coping(r= , p <0.001).Threat cognitive appraisal was also significantly associated with avoidant emotional coping (r= , p = 0.002).