title: Hostility and the clinical course of outpatients with congestive heart failure.
abstract: OBJECTIVE
  The role of depression and quality of life on clinical outcomes of congestive heart failure (CHF) is well recognised. However, there are fewer studies investigating the prognostic role of subclinical psychological distress and well-being impairments. The aims of this study were to evaluate clinical/subclinical psychological distress and well-being in CHF outpatients, and the influence of these psychological factors on adverse cardiac events (re-hospitalisation, cardiac death), at 4-year follow-up.
  
  
  METHODS
  Sixty-eight CHF outpatients underwent psychological assessment at baseline and, after 4 years, information about cardiac events was collected in 60 patients by means of clinical records.
  
  
  METHODS
  Psychological assessment included structured clinical interview for DSM (major/minor depression), Interview for diagnostic criteria for psychosomatic research (demoralisation), symptom questionnaire, psychological well-being scales.
  
  
  RESULTS
  At follow-up, 39.7% of the baseline sample reported cardiovascular events (14 CHF-related re-hospitalisations and 13 cardiac deaths) and 5.9% other causes for death. Among the variables examined as potential risk factors for adverse cardiovascular outcomes, only hostility was significant, even after controlling for disease severity (hazard ratio = 2.38, 95%confidence interval: 1.04-5.45, p = .040).
  
  
  CONCLUSIONS
  In outpatients with CHF, psychological assessment should include both clinical and subclinical distress such as hostility, in order to better address psychological risk factors for cardiac outcomes.
authors.affiliation: a Department of Psychology , University of Bologna , Bologna , Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Rafanelli
authors.affiliation: a Department of Psychology , University of Bologna , Bologna , Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Gostoli
authors.affiliation: b Discipline of Medicine , University of Adelaide , Adelaide , Australia.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
authors.affiliation: c Division of Cardiology , Bellaria Hospital , Bologna , Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Roncuzzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy*; D006791:Hostility; D006801:Humans; D008297:Male; D010045:Outpatients / Q000523:psychology* / Q000706:statistics & numerical data; D011788:Quality of Life; D012307:Risk Factors; D013315:Stress, Psychological; D016896:Treatment Outcome
keywords: anger; congestive heart failure; depression; hostility; prognosis; psychological well-being