The development and validation of a clinical measurement tool for fear of recurrence and progression in cardiac patients

Abstract One in two cardiac patients fear having another heart event or their cardiac condition worsening. Assessment of fear of recurrence and progression (FoRP) is critical to effective clinical care and chronic disease management. The current study aimed to develop and validate a measure of cardiac-FoRP - The Fear of Cardiac Recurrence and Progression Inventory (FCRPI). Items were generated by reviewing relevant literature and were refined in collaboration with key informants. The item pool (44 items) was administered to 241 adults (mean age = 64.52; 50% female) with a history of an acute coronary event, cardiac surgery, or chronic cardiac condition. Exploratory factor analysis identified the underlying factor structure and Rasch analysis assessed fit and reduced the item set. The final FCRPI comprised 29 items across five fear subscales relating to: deteriorating health, requiring further treatment, disengagement and loss of agency, impacts on intimacy, and impacts on work and finance, and two fear response subscales: avoidance and hyperawareness. The FCRPI demonstrated excellent internal consistency, and criterion and discriminant validity, and a clinically significant cut-off score of 39 was identified. The FCRPI offers both research and clinical utility by providing a validated tool to assess cardiac-specific FoRP and guide tailored interventions and patient-centred care.