title: Type-D personality but not implantable cardioverter-defibrillator indication is associated with impaired health-related quality of life 3 months post-implantation.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors: CoRPS, Department of Medical Psychology, Center of Research on Psychology in Somatic diseases, Room P503a, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE Tilburg, The Netherlands. s.s.pedersen@uvt.nl
authors: Susanne S
authors: SS
authors: Pedersen
authors: Dominic A M J
authors: DA
authors: Theuns
authors: Agnes
authors: A
authors: Muskens-Heemskerk
authors: Ruud A M
authors: RA
authors: Erdman
authors: Luc
authors: L
authors: Jordaens
mesh_terms: D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010551:Personality; D010554:Personality Disorders / Q000453:epidemiology* / Q000523:psychology*; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome