Henneke Versteeg

Type D personality and health status in cardiovascular disease populations: a meta-analysis of prospective studies

Background: Knowledge of the factors associated with individual differences in patient-reported outcomes is essential to identify high-risk patients and improve secondary prevention. Design: In this meta-analysis, we examined the association between Type D personality and the individual differences in patient-reported physical and mental health status among cardiovascular patients. Methods: A computerized search of the literature through PUBMED and PsychINFO (from 1995 to May 2011) was performed and prospective studies were selected that analysed the association between Type D personality and health status in cardiovascular patients. Two separate meta-analyses were performed for the association of Type D personality with physical and mental health status, respectively. Results: Of all identified studies, ten studies met the selection criteria. The meta-analyses showed that Type D was associated with a two-fold increased odds for impaired physical health status (3035 patients, OR 1.94, 95% CI 1.49–2.52) and a 2.5-fold increased odds for impaired mental health status (2213 patients, OR 2.55, 95% CI 1.57–4.16). There was no significant heterogeneity between the studies on physical health status (Qu2009=u200912.78; pu2009=u20090.17; I2u2009=u200929.59), but there was between those on mental health status (Qu2009=u200921.91; pu2009=u20090.003; I2u2009=u200968.04). Subgroup analyses showed that the association between Type D and mental health status decreased yet remained significant when adjusting for baseline health status. Conclusion: Type D personality was shown to be an independent correlate of impaired patient-reported physical and mental health status in various cardiovascular patient groups. Clinicians should be aware of the association between chronic psychological distress and poor patient-reported outcomes.

Posttraumatic stress in implantable cardioverter defibrillator patients: The role of pre-implantation distress and shocks☆

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Depression is independently associated with 7-year mortality in patients treated with percutaneous coronary intervention: Results from the RESEARCH registry

BACKGROUNDnDepression has been associated with poor prognosis in patients with coronary artery disease (CAD), but little is known about the impact of depression on long-term mortality. We examined whether depression was associated with 7-year mortality in patients treated with percutaneous coronary intervention (PCI), after adjusting for socio-demographic and clinical characteristics, anxiety, and the distressed (Type D) personality.nnnMETHODSnThe sample comprised a cohort of consecutive PCI patients (N=1234; 72.0% men; mean age 62.0 ± 11.1 years, range [26-90] years) from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. At baseline (i.e., 6 months post-PCI), patients completed the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression and the Type D scale (DS14) to assess Type D personality. The endpoint was defined as all-cause mortality.nnnRESULTSnThe prevalence of depression (HADS-D ≥ 8) was 26.2% (324/1236). After a median follow-up of 7.0 ± 1.6 years, 187 deaths (15.2%) from any cause were recorded. The incidence of all-cause mortality in depressed patients was 23.5% (76/324) versus 12.2% (111/910) in non-depressed patients. Cumulative hazard functions differed significantly for depressed versus non-depressed patients (log-rank X(2)=25.57, p<.001). In multivariable analysis, depression remained independently associated with all-cause mortality (HR=1.63; 95% CI [1.05-2.71], p=.038), after adjusting for socio-demographic and clinical characteristics, anxiety, and Type D personality.nnnCONCLUSIONSnDepression was independently associated with a 1.6-fold increased risk for 7-year mortality, above and beyond anxiety and Type D personality. Future studies are warranted to further elucidate the potential pathways linking depression to long-term mortality following PCI.

Disease‐specific health status as a predictor of mortality in patients with heart failure: a systematic literature review and meta‐analysis of prospective cohort studies

Some, but not all, studies have shown that patient‐reported health status, including symptoms, functioning, and health‐related quality of life, provides additional information to traditional clinical factors in predicting prognosis in heart failure patients. To evaluate the overall evidence, the association of disease‐specific health status on mortality in heart failure was examined through a systematic review and meta‐analysis.

Depression, not anxiety, is independently associated with 5-year hospitalizations and mortality in patients with ischemic heart disease

OBJECTIVEnThe objective of the current study was to examine whether depression and anxiety are independently associated with 5-year cardiac-related hospitalizations and all-cause mortality in patients with ischemic heart disease (IHD).nnnMETHODSnPatients treated for MI, angina, or ischemic heart failure (N=610) were recruited from Holbæk Hospital, Denmark. All patients completed the Hospital Anxiety and Depression Scale (HADS) in December 2005. Data regarding patient characteristics at baseline, and hospitalizations and deaths during follow-up were collected from Danish population-based registers. Cox and negative binomial regression analyses were performed to examine the relationship between depression, anxiety and the endpoints.nnnRESULTSnAt baseline, 71 (11.6%) patients reported depression and 120 (19.7%) reported anxiety. Models including both depression and anxiety showed that depression was independently associated with time to first cardiac-related hospitalization, cumulative number and length of cardiac-related hospitalizations, and all-cause mortality, while anxiety was only associated with the total length of hospitalizations (all p-values <.05). After adding sociodemographic and clinical factors, depression remained associated with the number (incidence rate ratio (IRR)=2.00, 95% confidence interval (CI): 1.44-2.77) and length of cardiac-related hospitalizations (IRR=3.69, 95% CI: 2.75-4.96), and all-cause mortality (hazard ratio (HR)=2.12, 95% CI: 1.13-3.96). The associations between depression and time to first hospitalization and between anxiety and length of stay were eliminated.nnnCONCLUSIONSnThe current study showed that depression, and not anxiety, is associated with the number and length of cardiac-related hospitalizations and all-cause mortality in IHD patients, independent of traditional risk factors. In order to improve health outcomes, better awareness and treatment of depression in IHD patients are crucial.

Psychological vulnerability, ventricular tachyarrhythmias and mortality in implantable cardioverter defibrillator patients: is there a link?

Implantable cardioverter defibrillator (ICD) therapy is the first-line treatment for the prevention of sudden cardiac death. Despite the demonstrated survival benefits of the ICD, predicting which patients will die from a ventricular tachyarrhythmia remains a major challenge. So far, psychological factors have not been considered as potential risk markers that might enhance the prediction of sudden cardiac death. This article evaluates the evidence for a link between psychological vulnerability, ventricular tachyarrhythmias and mortality and the pathways that might explain such a link. This review demonstrates that there is cumulative evidence supporting a link between psychological vulnerability and risk of ventricular tachyarrhythmias and mortality in ICD patients independent of disease severity and other biomedical risk factors. It may be premature to include psychological factors in risk algorithms, but information on the psychological profile of the patient may help to optimize the management and care of these patients in clinical practice.

Negative and positive affect are independently associated with patient-reported health status following percutaneous coronary intervention

PurposeWe examined the association between negative and positive affect and 12-month health status in patients treated with percutaneous coronary intervention (PCI) with drug-eluting stents.MethodsConsecutive PCI patients (nxa0=xa0562) completed the Global Mood Scale at baseline to assess affect and the EuroQoL-5D (EQ-5D) at baseline and 12-month follow-up to assess health status.ResultsNegative affect [F(1, 522)xa0=xa017.14, Pxa0<xa0.001] and positive affect [F(1, 522)xa0=xa05.11, Pxa0=xa0.02] at baseline were independent associates of overall health status at 12-month follow-up, adjusting for demographic and clinical factors. Moreover, there was a significant interaction for negative by positive affect [F(1, 522)xa0=xa06.11, Pxa0=xa0.01]. In domain-specific analyses, high negative affect was associated with problems in mobility, self-care, usual activities, pain/discomfort, and anxiety/depression with the risk being two to fivefold. Low positive affect was only associated with problems in self-care (OR: 8.14; 95% CI: 1.85–35.9; Pxa0=xa0.006) and usual activities (OR: 1.87; 95% CI: 1.17–3.00; Pxa0=xa0.009).ConclusionsBaseline negative and positive affect contribute independently to patient-reported health status 12xa0months post PCI. Positive affect moderated the detrimental effects of negative affect on overall health status. Enhancing positive affect might be an important target to improve patient-centered outcomes in coronary artery disease.

Poor health status and distress in cardiac patients: the role of device therapy vs. underlying heart disease.

AIMSnImplantable cardioverter defibrillator (ICD) therapy, which includes the risk of shocks, is considered the primary culprit of reductions in patient reported outcomes (PROs; e.g. health status and distress), thereby negating the role of underlying disease severity. We examined the relative influence of living with an ICD vs. congestive heart failure (CHF) on PROs and compared (i) ICD patients without CHF (ICD only), (ii) CHF patients without an ICD (CHF-only), and (iii) CHF patients with an ICD (ICD + CHF).nnnMETHODS AND RESULTSnSeparate cohorts of ICD and CHF patients (N = 435; 75% men) completed PROs at baseline, 6 and 12 months. Groups differed on physical health status only at baseline (F((2,415)) = 7.15, P = 0.001) and on anxiety at 12 months (F((2,415)) = 4.04, P = 0.01); ICD + CHF patients had the most impaired physical health status but the lowest anxiety level followed by the ICD only and CHF only patients. Congestive heart failure only patients had the most impaired mental health status and reported the highest level of anxiety as compared to the ICD only (P < 0.001) and ICD + CHF groups (P = 0.009), while the two latter groups did not differ. The effect sizes ranged from very small (0.03) to moderate-large (0.69). Groups did not differ in depression scores.nnnCONCLUSIONnCongestive heart failure patients reported worse PROs as compared to ICD patients, although the magnitude of the differences was relatively small. This suggests that the well being of patients is not necessarily negatively influenced by the implantation of an ICD, and that underlying heart disease may have at least an equal if not greater influence on PROs.

Monitoring device acceptance in implantable cardioverter defibrillator patients using the Florida Patient Acceptance Survey

Background: Patient device acceptance might be essential in identifying patients at risk for adverse patient‐reported outcomes following implantation of an implantable cardioverter defibrillator (ICD). We examined the validity and reliability of the Florida Patient Acceptance Scale (FPAS) and identified correlates of device acceptance in a Dutch cohort of ICD patients.

Patient-reported outcomes in Danish implantable cardioverter defibrillator patients with a Sprint Fidelis lead advisory notification

AIMSnFew studies have investigated the association between implantable cardioverter defibrillators (ICDs) and lead advisory notifications and patient-reported outcomes (PROs). We examined (i) whether the mode used to inform patients about a device advisory is associated with PROs, and (ii) whether patients with a lead subject to a device advisory report poorer PROs than non-advisory controls.nnnMETHODS AND RESULTSnPatients (n= 207) implanted with an ICD at Aarhus University Hospital, Denmark, with a Sprint Fidelis lead subject to an advisory and a non-advisory control group (n= 510), completed a set of standardized PRO measures. A Bonferroni correction was applied to all statistical PRO comparisons to adjust for multiple comparisons, with a P-value of 0.0038 (0.05/13 PROs) indicating statistical significance. Device advisory patients did not differ significantly on PROs according to mode of notification (all P-values >0.0038). They also did not differ significantly from controls on mean scores of depression, anxiety, device acceptance, and health status (all P > 0.0038). Differences were only found on ICD concerns (P< 0.0001) and on mental health status (P = 0.003), with advisory patients reporting fewer ICD concerns and a better mental health status than non-advisory controls.nnnCONCLUSIONSnThe mode used to inform ICD patients about the advisory was not associated with PROs, nor was the overall well-being of device advisory patients impaired compared to non-advisory controls. These results indicate that ICD patients are generally able to cope with a device advisory.