Journal Article

Type-D personality but not implantable cardioverter-defibrillator indication is associated with impaired health-related quality of life 3 months post-implantation

Susanne S Pedersen, Dominic AMJ Theuns, Agnes Muskens-Heemskerk, Ruud AM Erdman and Luc Jordaens

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 9, issue 8, pages 675-680
Published in print August 2007 | ISSN: 1099-5129
Published online April 2007 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eum041
Type-D personality but not implantable cardioverter-defibrillator indication is associated with impaired health-related quality of life 3 months post-implantation

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Aims Little is known about the impact of ICD indication (primary vs. secondary) on health-related quality of life (HRQL). Indication may also interact with psychological factors, such as personality. Using a prospective design, we examined whether ICD indication and type-D personality (i.e. experiencing increased negative emotions paired with emotional non-expression) serve as modulators of HRQL at baseline and 3 months post-implantation.

Methods and results Consecutively implanted ICD patients (n = 154) completed the Type-D Scale (DS14) at baseline and the Short-Form Health Survey 36 (SF-36) at baseline and 3 months. Of all patients, 82 (53%) received an ICD due to prophylactic reasons; the prevalence of type-D was 23%. Indication had no influence on HRQL (P = 0.75). Further stratification by personality showed a main effect for type-D personality (P < 0.001), with type-D patients generally experiencing poorer HRQL; there was no main effect for indication (P = 0.45) nor was the interaction effect indication by type-D significant (P = 0.22). There was a significant improvement in HRQL over time (P = 0.001). Type-D remained an independent predictor of impaired HRQL, adjusting for clinical factors and shocks during follow-up (P < 0.001). However, in adjusted analysis there was no longer a significant change in HRQL over time (P = 0.099).

Conclusion Type-D personality but not ICD indication was associated with impaired HRQL at the time of implantation and at 3 months. In the quest for enhancing risk stratification in clinical practice, personality factors, such as type-D, should not be ignored, as both type-D and poor HRQL have been associated with increased risk of mortality in cardiac patients.

Keywords: Health-related quality of life; Implantable cardioverter-defibrillator; Primary prevention; Secondary prevention; Type-D personality

Journal Article.  3978 words.  Illustrated.

Subjects: Cardiovascular Medicine

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