Prevalence and Outcomes of Fears in Advanced Heart Failure: Differences Across Disease Stages

Heart failure (HF) is a complex, multifactorial syndrome resulting from impaired heart function. When medical management of HF is ineffective, mechanical circulatory support with a left-ventricular assist device (LVAD) or heart transplantation are the only options for significantly extending patients' lives. Patients with HF experience various emotional reactions, including fears, which may impact their well-being44444 and disease management. Understanding how fears may differentially influence patients with HF depending on the stage of the disease is thus essential for delivering personalized care.

Among patients with advanced HF, disease-related and existential fears were associated with anxiety, depression, sleeplessness, loss of dignity, feelings of abandonment, uncertainty about the future, and restricted physical and social activities. The fears of patients with LVAD can be categorized into device-related, transplant-related, and psychological/emotional fears. Device-related fears involved maintaining the device in optimal condition, transplant-related fears included not surviving until transplantation or not receiving an organ, and psychological/emotional fears related to sexuality and disease progression, correlating with anxiety and depression. The fears experienced by heart transplant recipients fall into three main categories: avoidance, existential, and psychological fears. Avoidance fears lead to lower exercise motivation and higher anxiety, existential fears involved the fear of death leading to poor psychological well-being, and psychological fears included concerns about non-compliance repercussions, hypochondriacal responses, and appearing ungrateful. Each stage of HF disease presents unique fears with distinct implications, emphasizing the need for stage-specific psychological support and interventions. Further studies are required to understand the impact of fears in different stages of HF disease.