Predictors of Resilience Among Patients Living With Heart Failure Amid Escalating Sociopolitical Challenges: A Cross-Sectional Approach.

aimExposure to chronic illness and prolonged sociopolitical adversity may shape how patients adapt to illness-related demands; however, this relationship should be interpreted cautiously because stress can both challenge and undermine adaptive capacity. This study aimed to assess resilience and identify demographic, clinical, psychosocial, and self-care correlates of resilience among patients living with heart failure in Lebanon.

designA quantitative cross-sectional observational study.

methodsArabic-translated and psychometrically tested instruments were used to assess depressive symptoms, self-care, quality of life, and resilience. Data were collected between January 2024 and April 2025 from Arabic-speaking adults with confirmed heart failure recruited through convenience sampling from outpatient clinics and primary healthcare services across several Lebanese geographic regions. Descriptive statistics, bivariate analyses, correlation analyses, and multiple linear regression were conducted. Statistical significance was set at p < 0.05, and reporting followed the STROBE checklist.

resultsThe analysis included 299 participants with a mean age of 59.95 ± 15.89 years. Almost half of the participants were older adults with a mean age of 71.18 ± 6.06 years and a slightly higher proportion of males than females. Hypertension, diabetes, and hyperlipidemia were common. Mean left ventricular ejection fraction was 37.52% ± 10.51%, and most participants were classified as New York Heart Association functional class II or III. Mean scores indicated moderate depressive symptoms, impaired HF-related quality of life, and moderate resilience. Resilience was positively correlated with self-care maintenance [r = 0.54, p < 0.001], self-care monitoring [r = 0.47, p < 0.001], and self-care management [r = 0.53, p < 0.001] and was negatively correlated with quality of life [r = 0.055, p = 0.53], although this correlation was not significant. In the multiple linear regression model, self-care maintenance, self-care management, gender, and loop diuretic use were significant predictors of resilience, explaining 36.1% of the variance in resilience scores. Higher self-care maintenance and management scores and loop diuretic use were associated with higher resilience. Female gender was associated with lower resilience scores after adjustment.

conclusionLebanese patients living with heart failure reported moderate resilience in the context of ongoing sociopolitical and economic adversity. Higher resilience was consistently associated with stronger heart failure self-care behaviours, particularly self-care maintenance and management. IMPLICATIONS: This study addressed the limited evidence on resilience among patients living with heart failure in a context of prolonged sociopolitical and economic adversity. The main findings showed that patients had moderate resilience and that higher resilience was associated with stronger heart failure self-care behaviors. In multivariable analysis, higher self-care maintenance, higher self-care management, loop diuretic use, and male gender were associated with higher resilience. The findings should guide nursing practice in caring for patients with heart failure by identifying those at high risk for faltered resilience and aim for the factors associated with this poor outcome. This applies to the Lebanese context and to similar resource-constrained or crisis-affected settings to assess resilience, strengthen self-care behaviors, and provide context-sensitive support for patients living with heart failure. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct, or reporting.