Pre-implantation implantable cardioverter defibrillator concerns and Type D personality increase the risk of mortality in patients with an implantable cardioverter defibrillator.
OBJECTIVE
Little is known about the influence of psychological factors on prognosis in implantable cardioverter defibrillator (ICD) patients. We examined the influence of the distressed personality (Type D) and pre-implantation device concerns on short-term mortality in ICD patients.


RESULTS
Consecutively implanted ICD patients (N = 371; 79.5% men) completed the Type D Scale and the ICD Patient Concerns questionnaire prior to implantation and were followed up for short-term mortality. The prevalence of Type D was 22.4%, whereas 34.2% had high levels of ICD concerns. The incidence of mortality was higher in Type D vs. non-Type D patients [13.3% vs. 4.92%; hazard ratio (HR): 2.74; 95% confidence interval (CI): 1.24-6.03] and in patients with high vs. low levels of ICD concerns (11.0% vs. 4.5%; HR: 2.38; 95% CI: 1.08-5.23). Type D personality (HR: 2.79; 95% CI: 1.25-6.21) and high levels of ICD concerns (HR: 2.38; 95% CI: 1.06-5.34) remained independent predictors of mortality in separate analyses, adjusting for sex, age, ICD indication, coronary artery disease, and shocks. Patients with clustering of both Type D personality and high levels of pre-implantation concerns (HR: 3.86; 95% CI: 1.64-9.10) had a poorer survival compared with patients with one or none of these risk markers in adjusted analysis. Shocks during the follow-up period were also associated with mortality (HR: 3.09; 95% CI: 1.36-7.04).


CONCLUSIONS
Patients with a distressed personality and high levels of pre-implantation device-related concerns had a poorer prognosis, independent of other risk markers including shocks. This subgroup of patients should be identified in clinical practice and would likely benefit from a combined distress management programme and cardiac rehabilitation.
Pedersen
Susanne S
SS
Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Room P506, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE Tilburg, The Netherlands. s.s.pedersen@uvt.nl
van den Broek
Krista C
KC
Erdman
Ruud A M
RA
Jordaens
Luc
L
Theuns
Dominic A M J
DA
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality* / Q000503:physiopathology / Q000523:psychology*; D017147:Defibrillators, Implantable / Q000523:psychology* / Q000706:statistics & numerical data; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors