Impaired health status in Type D patients following PCI in the drug-eluting stent era

Abstract

Background: Drug-eluting stenting reduces restenosis post-percutaneous coronary intervention (PCI), but subgroups of patients may not benefit optimally from this procedure. We examined the impact of Type D personality on health status over time and the clinical relevance of Type D as a predictor of impaired health status at 12 months in unselected post-PCI patients. Methods: Consecutive patients (n = 692) participating in the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry completed the Type D Scale at 6 months and the Short Form Health Survey 36 (SF-36) at 6 and 12 months post-PCI. Results: Although there was a significant improvement in health status over time ( p < 0.001), Type D patients reported a substantially lower score on all health status domains of the SF-36 compared with non-Type D patients ( p < 0.001). Type D personality was an independent predictor of impaired health status on all SF-36 sub domains at 12 months except for physical functioning, adjusting for baseline demographic and clinical variables and health status at 6 months. In these adjusted analyses, Type D personality increased the likelihood of impaired health status at 12 months post-PCI from 60% (OR: 1.60; 95% CI: 1.04 -2.46) to almost 300% (OR: 3.99; 95% CI: 2.52 -6.32), varying among the parameters analyzed. Conclusions: Type D personality was associated with impaired health status in post-PCI patients treated in the drug-eluting stent era. The role of personality factors as determinants of clinical outcome and health status should not be overlooked as these factors may have much explanatory power. D

Type D Patients Report Poorer Health Status Prior to and After Cardiac Rehabilitation Compared to Non-Type D Patients

“…The findings of the current study are in line with previous studies in patients with peripheral arterial disease [13], treated with revascularization procedures [16,35], and patients with chronic heart failure [14], showing that Type D patients report poorer health status compared to non-Type D patients despite both personality taxonomies benefiting from medical treatment. In the present study, we found a non-significant interaction effect for Type D personality by time, indicating that personality did not moderate the effects of cardiac rehabilitation on health status but exerted a stable effect on health status over time.…”

Type D personality in Poland: Validity and application of the Polish DS14

“…Given that this is the first study to find such a high prevalence in CVD patients in Type D research to date, this finding should be replicated in other Eastern European studies. Nevertheless, if such a high prevalence is confirmed in future research, with the prevalence in CVD patients being almost twice as high as in the general population, this might have serious implications for Polish CVD patients and their clinical and psychosocial management, as Type D has been related to increased mortality and morbidity in Western European studies Schiffer, Pedersen, Widdershoven, Hendriks, Winter & Denollet, 2005;Al-Ruzzeh, Athanasiou, Mangoush, Wray, Modine, George, et al, 2005;Pedersen, Denollet, Ong, Serruys, Erdman & van Domburg, 2007;Denollet, Vaes & Brutsaert, 2000;Denollet, Pedersen, Ong, Erdman, Serruys & van Domburg, 2006;Pedersen, Lemos, van Vooren, Liu, Daemen, Erdman et al, 2004).…”

“…Others have also recommended the use of the DS14 as one of the measures to use in clinical cardiology practice to identify high-risk patients (Albus, Jordan & HerrmannLingen, 2004), as Type D has been associated with adverse health outcomes, including increased risk of mortality and morbidity Schiffer, Pedersen, Widdershoven, Hendriks, Winter & Denollet, 2005;, AlRuzzeh, Athanasiou, Mangoush, Wray, Modine, George, et al, 2005;Pedersen, Denollet, Ong, Serruys, Erdman & van Domburg, 2007;Denollet, Vaes & Brutsaert, 2000;Denollet, Pedersen, Ong, Erdman, Serruys & van Domburg, 2006;Pedersen, Lemos, van Vooren, Liu, Daemen, Erdman et al, 2004). The use of the DS14 could also be extended to other diseases, as Type D has been shown to predict the onset of cancer in patients with CVD (Denollet, 1998), although further cross-cultural research into the predictive validity of the Type D construct in relation to clinical outcomes in other somatic diseases is warranted.…”

“…The risk of mortality of those diseases associated with Type D is 4-fold, with this risk being independent of disease severity, traditional biomedical risk factors and mood states . Type D personality seems not just to be a phenomenon that is relevant to patients with coronary heart disease, where the construct was initially developed, but also in patients with chronic heart failure (Schiffer, Pedersen, Broers, Widdershoven & Denollet, 2008;Schiffer, Pedersen, Widdershoven, Hendriks, Winter & Denollet, 2005), peripheral arterial disease , and in patients treated with state-of-the-art invasive treatment, including percutaneous coronary intervention with drug-eluting stents (van Gestel, Pedersen, van de Sande, de Jaegere, Serruys, Erdman et al, 2007;Spindler, Pedersen, Serruys, Erdman & van Domburg, 2007;Pedersen, Denollet, Ong, Serruys, Erdman & van Domburg, 2007;Denollet, Pedersen, Ong, Erdman, Serruys & van Domburg, 2006) and device therapy (Pedersen, Van Domburg, Theuns, Jordaens & Erdman, 2004;Pedersen, Theuns, Muskens-Heemskerk, Erdman & Jordaens, 2007). NA and SI were not predictive of outcome individually; only the joint presence of high scores on both dimensions was linked to disease morbidity and mortality (Habra, Linden, Anderson, Weinberg, 2003).…”

“…Type D has been also associated with a broad range of patient-centered outcomes, including increased anxiety (van Gestel, Pedersen, van de Sande, de Jaegere, Serruys, Erdman et al, 2007;Spindler, Pedersen, Serruys, Erdman & van Domburg, 2007;Pedersen, Van Domburg, Theuns, Jordaens & Erdman, 2004;Schiffer, Pedersen, Broers, Widdershoven & Denollet, 2008), post-traumatic stress (Pedersen & Denollet, 2004), depressive symptoms Schiffer, Pedersen, Widdershoven, Hendriks, Winter & Denollet, 2005), vital exhaustion (Pedersen & Middel, 2001;Pedersen, Daemen, van de Sande, Sonnenschein, Serruys, Erdman et al, 2007), poor quality of life (AlRuzzeh, Athanasiou, Mangoush, Wray, Modine, George, et al, 2005;Pedersen, Denollet, Ong, Serruys, Erdman & van Domburg, 2007;, and adverse clinical events (Denollet, Vaes & Brutsaert, 2000;Denollet, Pedersen, Ong, Erdman, Serruys & van Domburg, 2006;Pedersen, Lemos, van Vooren, Liu, Daemen, Erdman et al, 2004).…”