title: Type D patients report poorer health status prior to and after cardiac rehabilitation compared to non-type D patients.
abstract: BACKGROUND
  Type D personality is an emerging risk factor in coronary artery disease (CAD). Cardiac rehabilitation (CR) improves outcomes, but little is known about the effects of CR on Type D patients.
  
  
  OBJECTIVE
  We examined (1) variability in Type D caseness following CR, (2) Type D as a determinant of health status, and (3) the clinical relevance of Type D as a determinant of health status compared to cardiac history.
  
  
  METHODS
  CAD patients (n = 368) participating in CR completed the Type D Scale, the Short-Form Health Survey 36 pre- and post-CR, and the Hospital Anxiety and Depression Scale pre-CR, to assess health status and depressive and anxious symptomatology, respectively.
  
  
  RESULTS
  The prevalence of Type D decreased from 26.6% to 20.7% (p = 0.012) following CR, but Type D caseness remained stable in 81% of patients. Health status significantly improved following CR [F(1,359) = 17.48, p < 0.001], adjusting for demographic and clinical factors and anxious and depressive symptoms. Type D patients reported poorer health status [F(1,359) = 10.40, p = 0.001], with the effect of Type D being stable over time [F(1,359) = 0.49, p = 0.48]. Patients with a cardiac history benefited less from CR [F(1,359) = 5.76, p = 0.02]. The influence of Type D on health status was larger compared to that for cardiac history, as indicated by Cohen's effect size index.
  
  
  CONCLUSIONS
  Type D patients reported poorer health status compared to non-Type D patients pre- and post-CR. In the majority of patients, CR did not change Type D caseness, with Type D being associated with a stable and clinically relevant effect on outcome. These high-risk patients should be identified in clinical practice and may require adjunctive interventions.
authors.affiliation: CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
authors.forename: Aline J
authors.initials: AJ
authors.lastname: Pelle
authors.forename: Ruud A M
authors.initials: RA
authors.lastname: Erdman
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Marquita
authors.initials: M
authors.lastname: Spiering
authors.forename: Marten
authors.initials: M
authors.lastname: Kazemier
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001007:Anxiety / Q000150:complications / Q000523:psychology; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000523:psychology* / Q000534:rehabilitation; D005260:Female; D006304:Health Status; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D010551:Personality / Q000145:classification / Q000502:physiology*; D010552:Personality Assessment; D012307:Risk Factors; D012649:Self Concept; D013694:Temperament / Q000502:physiology; D016896:Treatment Outcome