title: Positive affect moderates the effect of negative affect on cardiovascular disease-related hospitalizations and all-cause mortality after cardiac rehabilitation.
abstract: BACKGROUND
  Little is known as to whether negative emotions adversely impact the prognosis of patients who undergo cardiac rehabilitation. We prospectively investigated the predictive value of state negative affect (NA) assessed at discharge from cardiac rehabilitation for prognosis and the moderating role of positive affect (PA) on the effect of NA on outcomes.
  
  
  METHODS
  A total of 564 cardiac patients (62.49 ± 11.51) completed a comprehensive three-month outpatient cardiac rehabilitation program, filling in the Global Mood Scale (GMS) at discharge. The combined endpoint was cardiovascular disease (CVD)-related hospitalizations plus all-cause mortality at follow-up. Cox regression models estimated the predictive value of NA, as well as the moderating influence of PA on outcomes. Survival models were adjusted for sociodemographic factors, traditional cardiovascular risk factors, and severity of disease.
  
  
  RESULTS
  During a mean follow-up period of 3.4 years, 71 patients were hospitalized for a CVD-related event and 15 patients died. NA score (range 0-20) was a significant and independent predictor (hazard ratio (HR) 1.091, 95% confidence interval (CI) 1.012-1.175; p = 0.023) with a three-point higher level in NA increasing the relative risk by 9.1%. Furthermore, PA interacted significantly with NA (p < 0.001). The relative risk of poor prognosis with NA was increased in patients with low PA (p = 0.012) but remained unchanged in combination with high PA (p = 0.12).
  
  
  CONCLUSIONS
  The combination of NA with low PA was particularly predictive of poor prognosis. Whether reduction of NA and increase of PA, particularly in those with high NA, improves outcome needs to be tested.
authors.affiliation: Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital, Bern University Hospital and University of Bern, Switzerland Department of Clinical Research, University of Bern, Switzerland fiorenza.meyer@insel.ch.
authors.forename: Fiorenza Angela
authors.initials: FA
authors.lastname: Meyer
authors.affiliation: Department of Clinical Research, University of Bern, Switzerland Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.affiliation: Cardiovascular Prevention, Rehabilitation and Sports Medicine, Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Switzerland.
authors.forename: Hugo
authors.initials: H
authors.lastname: Saner
authors.affiliation: Cardiology Clinic, Tiefenauspital, Bern University Hospital, Bern, Switzerland.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Schmid
authors.affiliation: Heart Failure and Transplantation, Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Switzerland.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Stauber
mesh_terms: D000339:Affect; D000368:Aged; D000553:Ambulatory Care; D000704:Analysis of Variance; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology / Q000534:rehabilitation*; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Cardiovascular disease; cardiac rehabilitation; mortality; negative affect; positive affect; prospective longitudinal study