Cardiac patients' death anxiety: A systematic review and meta-analysis

Death anxiety (DA) is a critical psychological concern among patients with cardiovascular diseases (CVDs), yet its prevalence and associated factors remain understudied. This systematic review and meta-analysis aimed to determine the level of DA in cardiac patients and identify contributing factors. A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar yielded 27 cross-sectional studies (5292 participants). Studies were assessed using the AXIS tool, with most rated as high quality. Pooled estimates revealed moderate DA levels across studies, with mean scores of 8.46 (95 % CI: 7.05-9.86) for the Templer Death Anxiety Scale (TDAS) 0-15 range and 45.07 (95 % CI: 34.59-55.55) for the 15-75 range. Subgroup analyses indicated higher DA in Turkey (vs. Iran) and among coronary artery bypass graft (CABG) patients. Key factors linked to elevated DA included female gender, younger age, economic hardship, unemployment, reduced resilience, and diminished religious beliefs. Meta-regression found no significant moderation by age, sample size, or gender. These findings determine the need for targeted psychological interventions addressing modifiable factors like socioeconomic support and resilience-building in cardiac care. Limitations include reliance on cross-sectional data and heterogeneity in measurement tools. Future research should explore longitudinal and culturally diverse cohorts to clarify causal relationships and optimize DA management strategies.