| Objectives1.To understand the status of fear of progression in patients with chronic heart failure and analyze its influencing factors.2.To clarify the effect path between each factor and fear of progression in patients with chronic heart failure.3.To explore the change trajectory of fear of progression and its prediction role on the short-term readmission in patients with chronic heart failure.Methods1.Cross-sectional study:Patients with chronic heart failure hospitalized in the Department of Cardiology of two tertiary hospitals in Yangzhou from November 2021 to July 2022 were investigated by the convenience sampling method.The investigator-designed general information questionnaire,Fear of Progression Questionnaire-Short Form(FoP-Q-SF),10item Connor-Davidson Resilience Scale(CD-RISC-10),Heart Failure Somatic Perception Scale(HFSPS),Self-Care of Heart Failure Index(SCHFI)and Perceived Social Support Scale(PSSS)were used for patients who met the inclusion and exclusion criteria.2.Longitudinal study:From February 2022 to January 2023,patients with chronic heart failure enrolled in the cross-sectional study were followed up for 3 months and 6 months after discharge,respectively.The clinical endpoint events of patients were recorded by the cardiovascular adverse event record form by the telephone and outpatient follow-up.FoPQ-SF was used to assess the fear of disease progression again,and to analyse its short-term change trend.3.EpiData3.1 was used to input the information and establish a database.Statistical analysis was performed using SPSS 26.0 and Amos 24.0.Statistical methods included descriptive analysis(e.g.mean±standard deviation,median and interquartile,frequency and percentage),non-parametric test(Kolmogorov-Smirnov test),independent-sample t-test,one-way ANOVA,Pearson and Spearman correlation analysis,multiple linear regression,structural equation model analysis,repeated measures analysis of variance,Log-rank test and Cox survival analysis.Results1.The status and influencing factors of fear of progression in patients with chronic heart failureIn this survey,298 patients with chronic heart failure had different degrees of fear of progression.The total score of FoP was(30.54±6.53),fear of physical health was higher than social and family.Almost 34.2%of patients had psychological dysfunctional of fear of progression.Univariate analysis showed that there were significant statistical difference of FoP scores in age,per capita monthly income,HF hospitalizations within the past year,non-cardiovascular complications,NYHA class,number of cardiovascular oral drugs,left ventricular ejection fraction,out-of-pocket medical burden,and average hospitalization days(P<0.05).Correlation analysis showed that FoP was negatively associated with perceived social support(r=-0.507,P<0.01),psychological resilience(r=-0.636,P<0.01),self-care confidence(r=-0.679,P<0.01),and positively correlated with somatic symptom perception(r=0.578,P<0.01).Multiple stepwise linear regression showed that age(β=0.261),number of cardiovascular oral drugs(β=0.133),somatic symptom perception(β=0.336),psychological resilience(β=-0.183),and self-care confidence(β=-0.293)were influencing factors of fear of progression in patients with chronic heart failure,which could explain 67.4%of the total variation.2.Construction the structural equation model of influencing factors of fear of progression in patients with chronic heart failure based on the theory of Cognitive-phenomenologicaltransactionalIn this study,a path model of influencing factors of fear of progression in patients with chronic heart failure based on the theory of Cognitive-phenomenological-transactional was constructed and fitted well:χ2/df=2.535,GFI=0.964,AGFI=0.920,CFI=0.975,NFI=0.960,IFI=0.975,TLI=0.955,RMSEA=0.072.The negative effect of perceived social support on fear of progression was through by the indirect effects of psychological resilience,self-care confidence,and somatic symptom perception.The following five pathways included:①perceived social support→toughness→fear of progression(indirect effect:-0.262);②perceived social support→toughness→somatic symptom perception→fear of progression(indirect effect:-0.053);③perceived social support→self-care confidence→fear of progression(indirect effect:-0.338);④perceived social support→self-care confidence→somatic symptom perception→fear of progression(indirect effect:-0.052);⑤perceived social support→strength→somatic symptom perception→fear of progression(indirect effect:-0.100).Performing 5000 times of Bootstrap sampling was used to test the significance of the indirect mediation effect.The results showed that 95%CI of the pathway did not contain 0,indicating a significant mediation effect.3.The longitudinal study of the changing trajectory of fear of progression and its shortterm readmission in patients with chronic heart failureIn a 6-month short-term follow-up survey,the scores of FoP at three time points of T0T2 were(30.50±6.50),(28.96±6.69)and(28.63±6.60)points,respectively.The total score and the scores of each dimensions(physiological health,social and family)showed a slow downward trend.The incidence of unplanned readmission at 3 and 6 months after discharge was 18.2%and 30.7%,respectively.The results of Log-rank test showed that there was no statistically significant difference of psychological dysfunctional of fear of progression in the situation of 3-month readmission.The difference of fear of progression was statistically significant in the incidence of 6-month readmission in patients with chronic heart failure(P=0.005).Cox survival analysis showed that FoP was an independent predictor of unplanned readmission events for chronic heart failure within 6 months after discharge(HR=1.845,P<0.05),and the risk of readmission event in patients with psychological dysfunctional of fear of progression was 1.845 times higher than that in non-dysfunctional group.Conclusion1.The level of fear of progression in patients with chronic heart failure was at a medium level,and age,number of cardiovascular oral drugs,psychological resilience,somatic symptom perception,and self-care confidence were its influencing factors.Clinical staff should pay more attentions to patients’ dynamic emotions and identify fear of progression as soon as possible.Targeted and personalized psychological interventions can be provided for patients according to the influencing factors.2.Psychological resilience,self-care confidence,and somatic symptom perception have direct or indirect effects on fear of progression in chronic heart failure,and perceived social support also has an indirectly effect on fear of progression through psychological resilience,self-care confidence,and somatic symptom perception.In clinical practice,nursing staff should fully mobilize the internal and external superior resources of patients,establish a good family support system.In addition to,we are supposed to encourage patients to establish an optimistic and positive attitude and improve self-care efficacy,so as to relieve the fear of progression.3.Fear of progression in patients with chronic heart failure showed a slow decline overall During the six-month follow-up period.It is an important risk predictor of 6-month readmission after discharge in patients with chronic heart failure,which suggests that medical staff should pay attention to the continuity of care after discharge.Early attention should be paid to the negative emotions such as fear of progression in patients.It is of great significance to conduct an effective in discharge education and psychological counseling to reduce the risk of unplanned readmission. |
