Copingmechanismen und -dynamiken als Prädiktoren für die Lebensqualität sowie das somatische Outcome von Proband*innen mit einer Herzinsuffizienz oder Risikofaktoren dafür
Coping mechanisms and dynamics as predictors of quality of life and somatic outcome in subjects with heart failure or risk factors for heart failure
by Angelika Maria Schneider
Date of Examination:2025-02-11
Date of issue:2025-01-09
Advisor:Prof. Dr. Christoph Herrmann-Lingen
Referee:Prof. Dr. Christoph Herrmann-Lingen
Referee:Prof. Dr. Rolf Wachter
Referee:Prof. Dr. Ralf Dressel
Persistent Address:
http://dx.doi.org/10.53846/goediss-10934
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Abstract
English
Chronic heart failure is a highly prevalent disease. For the patients affected heart failure is associated with poor prognosis and, in most cases, a reduced quality of life. Some widespread diseases are considered risk factors for the development of heart failure. To deal with the ongoing stress of a chronic illness, coping strategies are used. The aim of this study was to analyze the prognostic value of different coping strategies and the variability within coping for quality of life and somatic outcome. The work is based on data from the longitudinal, observational DIAST-CHF study. The analysis included 1536 subjects who either had cardiovascular risk factors or were diagnosed with heart failure. Data was collected at baseline, after one, two, five and ten years. Coping was investigated using the Freiburg Questionnaire for Coping with Illness. To quantify coping variability, a contrast value was calculated from the scores of the individual strategies. Depending on the change in this contrast value over the first three timepoints, the subjects were divided into groups with and without coping variability. In addition, the maximum delta of the contrast value at the first three timepoints was used to quantify the coping variability. Health-related quality of life was assessed using Short Form-36 Health Survey. Somatic outcome was quantified by incidence of major adverse cardiac and cerebrovascular events and 6-minute-walking-distance as a measure of physical performance. Correlation and multiple linear regression analyses showed a significant prediction of health-related quality of life after five and ten years by coping strategies of the first two years of observation. Changes in the psychosocial quality of life could be explained to a greater extent by coping than variances in somatic quality of life. The results showed correlations between depressive coping and coping by minimization and wishful thinking at the first three timepoints with lower health-related quality of life over the course of the illness. After controlling for the initial quality of life depressive coping predicted a worse psychosocial and somatic quality of life after five – but not ten – years. After adjustment, minimization and wishful thinking predicted psychosocial quality of life after five and ten years - but not somatic quality of life. Active problem-orientated coping could not significantly predict health-related quality of life after adjustment. Minimization and wishful thinking was the only coping mechanism that significantly predicted an increased risk for cardiac and cerebrovascular events in the Cox regression and reduction in 6-minute-walking-dsitance at five years. The other coping strategies did not significantly predict somatic outcome. Coping variability showed no favorable or unfavorable correlation with the health-related quality of life or somatic outcome. Mixed linear models showed no significant differences in health-related quality of life or 6-minute-walking distance between the groups with and without coping variability. Also, incidence of cardiac and cerebrovascular events, which was analyzed using Cox regression analysis with the addition of covariates, did not differ between variable and non-variable coping groups. The maximum delta of the contrast value also showed no significant predictive value for quality of life or event risk in multiple linear regression. This study showed an association of depressive coping and minimization and wishful thinking with worse long-term quality of life in people at risk of heart failure or with manifest heart failure. Minimization and wishful thinking also predicted worse somatic outcome. Early screenings for depressive coping or coping by minimization and wishful thinking as well as interventions to reduce the use of these strategies could therefore contribute to a long-term improvement in mental and physical outcome. Further studies which examine the predictive value of minimization and wishful, which investigate the underlying pathophysiological mechanisms, or which investigate the benefit of interventions reducing minimization and wishful thinking and depressive coping could contribute to a deeper understanding of the role of coping in cardiological populations.
Keywords: heart failure; cardiovascular risk factors; coping strategies; event-free survival; somatic outcome; health-related quality of life; coping variability
