title: Failure to consult for symptoms of heart failure in patients with a type-D personality.
abstract: BACKGROUND
  Self-management and adequate consultation behaviour are essential for the successful treatment of chronic heart failure (CHF). Patients with a type-D personality, characterised by high social inhibition and negative affectivity, may delay medical consultation despite increased symptom levels and may be at an increased risk for adverse clinical outcomes.
  
  
  OBJECTIVE
  To examine whether type-D personality predicts poor self-management and failure to consult for evident cardiac symptoms in patients with CHF. Design/methods/
  
  
  METHODS
  178 outpatients with CHF (aged < or =80 years) completed the type-D Personality Scale at baseline, and the Health Complaints Scale (symptoms) and European Heart Failure Self-care Behaviour Scale (self-management) at 2 months of follow-up. Medical information was obtained from the patients' medical records.
  
  
  RESULTS
  At follow-up, patients with a type-D personality experienced more cardiac symptoms (OR 6.4; 95% CI 2.5 to 16.3, p<0.001) and more often appraised these symptoms as worrisome (OR 2.9; 95% CI 1.3 to 6.6, p<0.01) compared with patients with a non-type-D personality. Paradoxically, patients with a type-D personality were less likely to report these symptoms to their cardiologist/nurse, as indicated by an increased risk for inadequate consultation behaviour (OR 2.7; 95% CI 1.2 to 6.0, p<0.05), adjusting for demographics, CHF severity/aetiology, time since diagnosis and medication. Accordingly, of 61 patients with CHF who failed to consult for evident cardiac symptoms, 43% had a type-D personality (n = 26). Of the remaining 108 patients with CHF, only 14% (n = 16) had a type-D personality.
  
  
  CONCLUSIONS
  Patients with CHF with a type-D personality display inadequate self-management. Failure to consult for increased symptom levels may partially explain the adverse effect of type-D personality on cardiac prognosis.
authors.affiliation: Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands. angelique.schiffer@uvt.nl
authors.forename: Angélique A
authors.initials: AA
authors.lastname: Schiffer
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.forename: Jos W
authors.initials: JW
authors.lastname: Widdershoven
authors.forename: Eric H
authors.initials: EH
authors.lastname: Hendriks
authors.forename: Otto R F
authors.initials: OR
authors.lastname: Smith
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D008297:Male; D009341:Negativism; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010551:Personality; D012044:Regression Analysis; D012307:Risk Factors; D012648:Self Care; D012919:Social Behavior