What is the clinical evidence from this study?

Study design: Systematic Review. Population: Heart failure. Primary outcome: Average levels of death anxiety.

What question did this study set out to answer?

This review aims to synthesize observational evidence regarding death anxiety among patients with heart failure.

March 26, 2026Open Access

Death anxiety in patients with heart failure: an updated integrative review

Key Result

Patients with heart failure consistently experience moderate to high levels of death anxiety, which is significantly predicted by older age, loneliness, and longer disease duration.

Key Points

This review aims to synthesize observational evidence regarding death anxiety among patients with heart failure.
Conducted a comprehensive literature search across five major databases.
Included primary research studies published in English from January 2014 to March 2025.
Focused on studies that quantitatively assessed death anxiety and its correlates.
Identified 12 eligible studies revealing moderate to high levels of death anxiety among patients.
Found key predictors include older age, loneliness, low socioeconomic status, and longer duration of heart failure.
Highlighted protective factors such as spiritual orientation, religious coping, and resilience.
Cognitive-behavioral therapy and illness perception training showed significant reductions in death anxiety.

Study Design

Type

Systematic Review

Structured PICO

Population

Patients with heart failure (HF) across 12 observational studies.

Outcome

Prevalence, predictors, and psychosocial correlates of death anxietypatient reported

Death anxiety is a prevalent and impactful concern among patients with heart failure, highlighting the need for routine assessment and integration of psychosocial and spiritual care.

Limitations

Search was limited to published studies in English, raising concerns about potential publication bias.
Included only 12 studies, reflecting the nascent stage of research in this area.
Majority of the studies originated from Middle Eastern countries, which may restrict applicability to other cultural contexts.
Variability in death anxiety measures and scoring systems complicated direct comparisons of severity across studies.

Abstract

Abstract Objective This integrative review aims to synthesize observational evidence on the prevalence, predictors, and psychosocial correlates of death anxiety in patients with heart failure (HF). Methods A comprehensive literature search was conducted using 5 major databases: Scopus, PubMed, ScienceDirect, Embase, and ProQuest. Inclusion criteria were primary research studies published in English between January 2014 and March 2025 that quantitatively assessed death anxiety among patients with HF and explored its associations with demographic, clinical, or psychosocial variables. Results A total of 12 eligible studies were identified and systematically reviewed, revealing that death anxiety is moderate to high among most samples. Key predictors of this anxiety included older age, feelings of loneliness, low socioeconomic status, and longer duration of HF. Additionally, several studies highlighted protective factors such as spiritual orientation, religious coping, and resilience. Interventions, including cognitive-behavioral therapy (CBT) and illness perception training, showed significant reductions in death anxiety. Conclusions Death anxiety is a prevalent and impactful concern among Patients with HF, influenced by both individual and contextual factors. Routine assessment and integration of psychosocial and spiritual care—alongside evidence-based psychological interventions—are essential to address this critical aspect of HF management.

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