title: Lack of prognostic value of type D personality for mortality in a large sample of heart failure patients.
abstract: BACKGROUND
  Type D personality has been proposed as a prognostic indicator for mortality in cardiovascular disease. Most research examining this construct originates from one research group, and it is critical that the predictive value of Type D personality for adverse outcomes is independently cross-validated. This study examined its prognostic value in heart failure, relative to B-type natriuretic peptide (BNP) and depressive symptoms.
  
  
  METHODS
  We studied 706 patients with complete BNP, depressive symptom, and Type D personality and mortality data from 958 patients with heart failure enrolled after hospitalization for a multisite study of a disease management program. Multivariable models were adjusted for BNP and depression.
  
  
  RESULTS
  At 18 months, there were 192 deaths (27.2%). No evidence was found for a prognostic value of Type D personality in the unadjusted model (hazard ratio [HR] = 0.893, 95% confidence interval [CI] = 0.582-1.370). In contrast, BNP was significantly predictive of mortality (HR = 1.588, 95% CI = 1.391-1.812), whereas depression was not (HR = 1.011, 95% CI = 0.998-1.024). Type D was also not predictive in covariate-adjusted models (HR = 0.779, 95% CI = 0.489-1.242). Similar results were obtained when analyzing Type D as the interaction between continuous z scores of its two components, negative affectivity and social inhibition (p = .144).
  
  
  CONCLUSIONS
  In the largest study to date, Type D does not predict mortality. Future research should construe Type D as the interaction of continuous negative affectivity and social inhibition z scores, rather than as a typology, and consider analyses replacing negative affectivity with depression.
authors.affiliation: Health Psychology Section, Department of Health Science, University Medical Center Groningen, University of Groningen, HPC FA12, PO Box 196, NL-9700 AD Groningen, The Netherlands. jcoynester@gmail.com
authors.forename: James C
authors.initials: JC
authors.lastname: Coyne
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Luttik
authors.forename: Eric
authors.initials: E
authors.lastname: van Sonderen
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Robbert
authors.initials: R
authors.lastname: Sanderman
mesh_terms: D000368:Aged; D003863:Depression / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010551:Personality / Q000502:physiology; D010555:Personality Inventory; D011379:Prognosis; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales
chemical_list: D020097:Natriuretic Peptide, Brain