title: Effects of expanded cardiac rehabilitation on psychosocial status in coronary artery disease with focus on type D characteristics.
abstract: Type D personality has been shown to increase the risk for cardiovascular events in patients with coronary artery disease (CAD). We investigated the effects of expanded cardiac rehabilitation on type D score and psychosocial characteristics in 224 CAD patients randomised to either expanded cardiac rehabilitation (stress management, increased physical training, stay at a "Patient Hotel" after discharge and cooking sessions), or routine rehabilitation. Follow-up was 1 year. At baseline patients with a high type D score [patients in the upper quartile of type D score (Q4) i.e., type D patients] had a lower sense of coherence (p < 0.001), a lower quality of life (p < 0.001), more depressive symptoms (p < 0.001) and increased anxiety (p < 0.001) as compared to patients with a low type D score (Q1). During follow-up, type D patients (Q4) randomised to intervention had significant decrements in type D-score (p < 0.01), depression and anxiety (p < 0.05) and an increment in quality of life scores (p < 0.001). Quality of life was also improved in control type D patients (Q4; p < 0.01) but no significant changes were seen in type D score, depression or anxiety. Expanded cardiac rehabilitation reduces type D score, anxiety and depressive symptoms, and improves the quality of life in type D patients.
authors.affiliation: Division of Cardiology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 18288 Stockholm, Sweden. monica.rydell-karlsson@ds.se
authors.forename: Monica Rydell
authors.initials: MR
authors.lastname: Karlsson
authors.forename: Catrin
authors.initials: C
authors.lastname: Edström-Plüss
authors.forename: Claes
authors.initials: C
authors.lastname: Held
authors.forename: Peter
authors.initials: P
authors.lastname: Henriksson
authors.forename: Ewa
authors.initials: E
authors.lastname: Billing
authors.forename: N Håkan
authors.initials: NH
authors.lastname: Wallén
mesh_terms: D000359:Aftercare / Q000523:psychology; D000368:Aged; D001007:Anxiety / Q000534:rehabilitation; D003131:Combined Modality Therapy; D003296:Cooking; D003327:Coronary Disease / Q000523:psychology / Q000534:rehabilitation*; D003863:Depression / Q000523:psychology; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D006294:Health Resorts; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology / Q000534:rehabilitation*; D010353:Patient Education as Topic; D010555:Personality Inventory; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012064:Relaxation Therapy; D012803:Sick Role; D013315:Stress, Psychological / Q000150:complications*; D013548:Sweden; D014434:Type A Personality