title: Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy.
abstract: It is well known that a significant proportion of heart failure patients (10-44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation.
  
  
  
  A cohort of 139 patients with a CRT-defibrillator (70 % men; age 65.7 ± 10.1 years) completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) prior to implantation (baseline) and at 2, 6, and 12-14 months post-implantation. Latent class analyses were used to identify trajectories and associates of disease-specific health status over time.
  
  
  
  All health status trajectories showed an initial small to large improvement from baseline to 2-month follow-up, whereafter most trajectories displayed a stable pattern between short- and long-term follow-up. Low educational level, NYHA class III/IV, smoking, no use of beta-blockers, use of psychotropic medication, anxiety, depression, and type D personality were found to be associated with poorer health status in unadjusted analyses. Interestingly, subgroups of patients (12-20 %) who experienced poor health status at baseline improved to stable good health status levels after implantation.
  
  
  
  Levels of disease-specific health status vary considerably across subgroups of CRT-D patients. Classification into poorer disease-specific health status trajectories was particularly associated with patients' psychological profile and NYHA classification. The timely identification of CRT-D patients who present with poor disease-specific health status (i.e., KCCQ score < 50) and a distressed psychological profile (i.e., anxiety, depression, and/or type D personality) is paramount, as they may benefit from cardiac rehabilitation in combination with psychological intervention.
authors.affiliation: Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.|CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
authors.forename: Mirjam H
authors.initials: MH
authors.lastname: Mastenbroek
authors.affiliation: Department of Psychology, University of Southern Denmark, Odense, Denmark.|Department of Cardiology, Odense University Hospital, Odense, Denmark.|Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.affiliation: Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
authors.forename: Mathias
authors.initials: M
authors.lastname: Meine
authors.affiliation: Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands. h.versteeg-4@umcutrecht.nl.|CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands. h.versteeg-4@umcutrecht.nl.
authors.forename: Henneke
authors.initials: H
authors.lastname: Versteeg
mesh_terms: D000368:Aged; D001007:Anxiety; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D003863:Depression; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D064415:Type D Personality
keywords: Cardiac resynchronization therapy; Health status; Heart failure; KCCQ; Trajectories