Conceptualizing fear of progression in cardiac patients: Advancing our understanding of the psychological impact of cardiac illness

Background: An emerging area of psycho-cardiology explores fear of disease progression in cardiac patients, following extensive research of this topic in psycho-oncology. Novel interventions that target cardiac fear of progression(FoP) may be valuable in bridging the gap between the high psychological support needs in cardiac care and limitations surrounding the efficacy of standard psychosocial treatments. However, there appears to be limited research characterizing FoP in cardiac patients with which to inform potential interventions. Aims: Using a mixed methods approach in two inter-related studies, we aimed to develop a preliminary conceptualization of cardiac-FoP. Methods: Study 1 involved a scoping review of existing qualitative research to identify the range of fears relating to disease progression reported by cardiac patients. Study 2 investigated the prevalence and distress levels associated with a selection of fears identified in Study 1 through a quantitative study of 194 cardiac patient admissions at two Australian hospitals. Results: Study 1 conceptualized cardiac-FoP in two ways, by the content of the fears and by the behavioral responses to the fears. Fears were categorized into seven broad domains: fears associated with death, health, interpersonal relationships, treatment, accessing help, role responsibilities, and physical activity. Five categories of behavioral responses were identified: avoidance, hyperawareness, symptom misattribution, seeking help, and lifestyle changes. Study 2 indicated a high prevalence of fear, with an average endorsement of 40.9%. When fear was endorsed, an average of 45.2% of cardiac patients experienced moderate-to-severe distress. Discussion: This paper provides an initial conceptualization of FoP in cardiac patients, providing preliminary evidence of the rates of fear and associated distress in this population. Drawing on this conceptualization, unique measurement tools and interventions should be developed to identify and address FoP in cardiac patients.