*4.1.1.2 Negative emotions related to heart failure*

In addition to sustaining optimistic feelings by hoping that life will be prolonged with evidence-based drug treatments, devices, or surgical options, the culture and beliefs of patients, complex treatments, the presence of symptoms, disability, and negative developments in the disease process can cause negative feelings such as a sense of uncertainty, anxiety, and fear in many patients with advanced heart failure. Emotions such as hopelessness, depression, and anger experienced by heart failure patients can constitute a significant barrier to the self-care process by creating feelings of a lack of interest in life and preferring death to life [18].
