Inadequate consultation behavior modulates the relationship between Type D personality and impaired health status in chronic heart failure
Introduction
Prevalence and incidence of chronic heart failure (CHF) have increased tremendously during recent years, due to improved survival after myocardial infarction and an aging population [1], [2], [3]. Consequently, CHF poses a substantial burden on both health care systems and patients, as it is a major cause of mortality [4], (re)hospitalization [5], and impaired health status [6].
Psychological risk factors for impaired health outcomes in coronary heart disease (CHD) have been acknowledged [7], with Type D personality (i.e. the joint tendency of the personality traits negative affectivity and social inhibition) being such a risk factor [8]. Type D persons experience a broad range of negative emotions and are at the same time not likely to express these emotions in social interactions, because they fear disapproval or rejection by others [9]. It has been shown that Type D personality is an independent predictor of mortality, morbidity, health status, and psychological distress in various patient groups [10], [11], [12], [13].
Apart from knowing which patients are at high risk for impaired health outcomes, the identification of pathways linking Type D personality to these outcomes is also important, but largely unknown [14]. Inadequate self-management behavior may be one of these mechanisms, as it has been shown to be independently associated with adverse health outcomes in CHF [15], [16]. Self-management is defined as the ability to manage symptoms, treatment, physical and psychosocial consequences, and life-style changes inherent in living with a chronic condition [17]. A recent study showed that CHF patients with a Type D personality reported more cardiac symptoms and were more likely to worry about those symptoms, as compared to non-Type Ds. However, Type Ds were at an increased risk for not consulting their doctor or nurse for these symptoms. Thus, Type D CHF-patients displayed inadequate consultation behavior, a specific component of self-management [18]. As consultation behavior is of crucial importance to prevent clinical deterioration, this might partly explain the inverse relationship between Type D personality and health status. Therefore, in the current study we prospectively examined the relationship between Type D personality and impaired health status as well as inadequate consultation behavior.
Section snippets
Patient population, design, and procedure
The design and procedure of patient selection have been described previously [18]. In this study we report results based on of a part of that study sample. However, here we report on an enlarged sample and extended the follow-up period from two to six-months. Between October 2003 and November 2006, 457 consecutive CHF patients from the cardiology outpatient unit of the TweeSteden teaching hospital in Tilburg, The Netherlands, were approached for the current study. Since 73 patients initially
Patient characteristics
Participants and non-participants differed on some baseline characteristics, with non-participants being older (69.6 versus 65.7 years; t(384) = 3.00, p = .003), more likely to be female (47.9% versus 28.8%; X2(1) = 9.96, p = .002) and to use aspirin (66.7% versus 43.1%; X2(1) = 13.00, p < .001), compared to participants. Patient characteristics stratified by Type D personality are presented in Table 2. Significant differences between Type D and non-Type D patients were found only with respect to
Discussion
To the best of our knowledge, this is the first prospective study that reported on the relationship between Type D personality, inadequate consultation behavior, and impaired health status in CHF patients. We found Type D patients to be at an almost 2-fold risk for failing to consult for CHF symptoms. In addition, Type D personality independently predicted impaired health status at 6-month follow-up, and inadequate consultation behavior was independently associated with impaired health status,
Acknowledgments
This research was supported by a VICI grant (453-04-004) from the Netherlands Organisation for Scientific Research (NWO) and by a grant (2003B038) from The Dutch Heart Foundation to Johan Denollet, PhD.
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [39].
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