Longitudinal trajectories of kinesiophobia and associated factors in patients with chronic heart failure

Kinesiophobia is prevalent among patients with chronic heart failure (CHF), adversely affecting exercise adherence and rehabilitation outcomes. However, longitudinal evidence regarding its temporal change patterns and population heterogeneity is scarce. To identify distinct trajectories of kinesiophobia in patients with CHF during the first year post-discharge and to explore their associated factors. A prospective longitudinal observational study was conducted between May 2022 and June 2024 involving 277 patients with CHF. Kinesiophobia was assessed using the Tampa Scale for Kinesiophobia-Heart (TSK-SV Heart) at discharge, and at 3 months, 6 months, and 12 months post-discharge. Group-based trajectory modeling (GBTM) identified alteration patterns by comparing 1 to 5 classes. Random forest analysis ranked variable importance, and multinomial logistic regression identified factors associated with trajectory classes. Three distinct kinesiophobia development trajectories were identified: Persistently Low Fear (43.3%), Progressively Increasing Fear (32.5%), and Persistently High Fear (24.2%). Compared to the Persistently Low group, the Persistently High trajectory was associated with a higher NYHA class ( P < 0.001) and a greater symptom burden ( P = 0.001). Conversely, a higher LVEF was associated with a lower likelihood of belonging to the Persistently High group ( P = 0.024). Compared to the Persistently Low group, the Progressively Increasing trajectory was associated with a greater symptom burden ( P = 0.002) and more severe fatigue ( P = 0.002). Kinesiophobia in patients with CHF exhibited three heterogeneous trajectories during the first year post-discharge. Symptom burden, NYHA class, LVEF, and fatigue were significantly associated factors. These should be incorporated into stratified assessment and continuous follow-up early after discharge to implement targeted interventions.