Introduction
One of the most common chronic diseases is coronary heart disease, which is recognized as the leading cause of death in most parts of the world [10]. Adherence to self-care behaviors, in addition to preventing the exacerbation of signs and symptoms, plays a significant role in reducing the number of hospitalizations, reducing mortality, and reducing medical costs [16]. Death anxiety is one of the most common types of anxiety experienced by people with cardiovascular diseases [21]. 
Since self-compassion plays an important role in reducing mental disorders, especially anxiety [29], the present study aimed to determine the mediating role of self-compassion in the relationship between self-care and death anxiety in older adults with coronary artery disease.

Methods & Materials
This is a descriptive analytical study with a cross-sectional design, conducted on older adults with coronary diseases referred to the heart clinics of Bu Ali, Velayat, and Mohammadzadeh hospitals in Qazvin, Iran, in 2024. Inclusion criteria were age ≥60 years, diagnosis of coronary heart disease, ability to answer questions, and informed consent to participate in the present study. Exclusion criteria were severe physical, cognitive, and psychological problems that could prevent communication and answering the questions. A convenience sampling method was used to select eligible individuals.
To collect data, a demographic form, Neff’s Self-Compassion scale (SCS), Dickson’s Self-care of Coronary Heart Disease Inventory (SC-CHDI), and the Templar death anxiety scale (TDAS) were used. The questionnaires were completed through interviews with the participants from April to June 2024. SPSS software, version 25 and STATA software, version 14 were used to analyze the data. Path analysis was used to examine the mediating role of self-compassion in the relationship between death anxiety and self-care. The significance level was set at 0.05.

Results
In this study, 310 older adults with a mean age of 67.64±7.48, ranging from 60 to 97 years, participated. The mean age at onset of disease was 59.51±9.07. Most of the participants were female (n=166, 53.5%) and married (n=229, 73.9%). The mean TDAS score was 8.07±2.83, indicating a higher-than-average level of death anxiety. The mean SC-CHDI score was 66.53±17.42, indicating a low self-care level. The mean SCS score was 38.88±6.46, indicating a higher-than-average level of self-compassion in the elderly.
A significant and positive relationship was observed between self-care and death anxiety; with increasing self-care, death anxiety also increases (P<0.001, B=0.20). There was a significant and inverse relationship between death anxiety and self-compassion; with increasing self-compassion, death anxiety decreases (P<0.001, B=-0.25). In addition, a significant and positive relationship was found between self-care and self-compassion; as self-compassion increases in the elderly, the level of self-care also increases (P<0.001, B=0.28). Finally, the role of self-compassion as a mediating factor in the relationship between self-care and death anxiety was confirmed both directly and indirectly through self-compassion. (P=0.001, B=-0.07)

Conclusion
The results of the present study showed a significant and direct relationship between self-care and death anxiety in Iranian older adults with coronary artery disease. It seems that the elderly in our study showed a greater tendency to practice self-care due to their high perception of the disease state and death anxiety. This high death anxiety can act as a stimulus to increase self-care in this group. Based on the results of the present study, older patients with more self-compassion show less death anxiety. People who have more self-compassion may use better emotion regulation strategies, enabling them to deal with an anxiety-provoking situation more effectively. The mediating role of self-compassion in the relationship between self-care and death anxiety in older adults with coronary artery disease was confirmed. Self-compassion is an emotional regulation strategy that does not prevent unpleasant experiences; however, the unpleasant effects are accepted kindly by the patients and protect them from the negative consequences of the experienced anxiety. Therefore, it is recommended that health professionals and nurses implement educational and intervention programs to enhance self-compassion in older adults with coronary heart disease. These measures can reduce death anxiety and increase the level of self-care in this group of patients, ultimately improving their quality of life (QoL).

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Qazvin University of Medical Sciences (Code: IR.QUMS.REC.1402.398). Before the study, after explaining the study objectives to the participants and assuring them of the confidentiality of their information, written informed consent was obtained from them.

Funding
This article was extracted from the masters thesis of Fatemeh Mohammadi Dargah in Geriatric Nursing at the Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Conceptualization, methodology, investigation, writing, editing & review, sources: Fatemeh Mohammadi Dargah, Mojtaba Senmar and Seyedah Ameneh Motalebi; Analysis: Hosseinkhani Zahra; Funding acquisition: Fatemeh Mohammadi Dargah; Project administration: Seyedah Ameneh Motalebi.

Conflicts of interest
The authors declare no conflict of interest

Acknowledgments
The authors would like to thank  all seniors who participated in this study.

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