Prognostic importance of distressed (Type D) personality and shocks in patients with an implantable cardioverter defibrillator

J. Denollet, F.B. Tekle, S.S. Pedersen, P.H.J. van der Voort, M. Alings, K.C. van den Broek

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Abstract

Background
Clinical trials have shown the benefit of implantable cardioverter defibrillator (ICD) treatment. In this study, we examined the importance of chronic psychological distress and device shocks among ICD patients seen in clinical practice.
Methods
This prospective follow-up study included 589 patients with an ICD (mean age = 62.6 ± 10.1 years; 81% men). At baseline, vulnerability for chronic psychological distress was measured by the 14-item Type D (distressed) personality scale. Cox regression models of all-cause and cardiac death were used to examine the importance of risk markers.
Results
After a median follow-up of 3.2 years, 94 patients (16%) had died (67 cardiac death), 61 patients (10%) had experienced an appropriate shock and 28 (5%) an inappropriate shock. Inappropriate shocks were not associated with all-cause (p = 0.52) or cardiac (p = 0.99) death. However, appropriate shocks (HR = 2.60, 95% CI 1.47–5.58, p = 0.001) and Type D personality (HR = 1.85, 95% CI 1.12–3.05, p = 0.015) were independent predictors of all-cause mortality, adjusting for age, sex, left ventricular ejection fraction, cardiac resynchronization therapy (CRT), secondary indication, history of coronary artery disease, medication and diabetes. Type D personality and appropriate shocks also independently predicted an increased risk of cardiac death. Other independent predictors of poor prognosis were older age, treatment with CRT and diabetes.
Conclusion
Vulnerability to chronic psychological distress, as defined by the Type D construct, had incremental prognostic value above and beyond clinical characteristics and ICD shocks. Physicians should be aware of chronic psychological distress and device shocks as markers of an increased mortality risk in ICD patients seen in daily clinical practice.
Keywords: Implantable cardioverter defibrillator, Mortality, Shocks, Type D personality
Original languageEnglish
Pages (from-to)2705-2709
JournalInternational Journal of Cardiology
Volume167
Issue number6
DOIs
Publication statusPublished - 2013

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Implantable Defibrillators
Equipment and Supplies
Proportional Hazards Models
Cause of Death
Physicians

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Denollet, J. ; Tekle, F.B. ; Pedersen, S.S. ; van der Voort, P.H.J. ; Alings, M. ; van den Broek, K.C. / Prognostic importance of distressed (Type D) personality and shocks in patients with an implantable cardioverter defibrillator. In: International Journal of Cardiology. 2013 ; Vol. 167, No. 6. pp. 2705-2709.
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title = "Prognostic importance of distressed (Type D) personality and shocks in patients with an implantable cardioverter defibrillator",
abstract = "BackgroundClinical trials have shown the benefit of implantable cardioverter defibrillator (ICD) treatment. In this study, we examined the importance of chronic psychological distress and device shocks among ICD patients seen in clinical practice.MethodsThis prospective follow-up study included 589 patients with an ICD (mean age = 62.6 ± 10.1 years; 81{\%} men). At baseline, vulnerability for chronic psychological distress was measured by the 14-item Type D (distressed) personality scale. Cox regression models of all-cause and cardiac death were used to examine the importance of risk markers.ResultsAfter a median follow-up of 3.2 years, 94 patients (16{\%}) had died (67 cardiac death), 61 patients (10{\%}) had experienced an appropriate shock and 28 (5{\%}) an inappropriate shock. Inappropriate shocks were not associated with all-cause (p = 0.52) or cardiac (p = 0.99) death. However, appropriate shocks (HR = 2.60, 95{\%} CI 1.47–5.58, p = 0.001) and Type D personality (HR = 1.85, 95{\%} CI 1.12–3.05, p = 0.015) were independent predictors of all-cause mortality, adjusting for age, sex, left ventricular ejection fraction, cardiac resynchronization therapy (CRT), secondary indication, history of coronary artery disease, medication and diabetes. Type D personality and appropriate shocks also independently predicted an increased risk of cardiac death. Other independent predictors of poor prognosis were older age, treatment with CRT and diabetes.ConclusionVulnerability to chronic psychological distress, as defined by the Type D construct, had incremental prognostic value above and beyond clinical characteristics and ICD shocks. Physicians should be aware of chronic psychological distress and device shocks as markers of an increased mortality risk in ICD patients seen in daily clinical practice.Keywords: Implantable cardioverter defibrillator, Mortality, Shocks, Type D personality",
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Prognostic importance of distressed (Type D) personality and shocks in patients with an implantable cardioverter defibrillator. / Denollet, J.; Tekle, F.B.; Pedersen, S.S.; van der Voort, P.H.J.; Alings, M.; van den Broek, K.C.

In: International Journal of Cardiology, Vol. 167, No. 6, 2013, p. 2705-2709.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Prognostic importance of distressed (Type D) personality and shocks in patients with an implantable cardioverter defibrillator

AU - Denollet, J.

AU - Tekle, F.B.

AU - Pedersen, S.S.

AU - van der Voort, P.H.J.

AU - Alings, M.

AU - van den Broek, K.C.

PY - 2013

Y1 - 2013

N2 - BackgroundClinical trials have shown the benefit of implantable cardioverter defibrillator (ICD) treatment. In this study, we examined the importance of chronic psychological distress and device shocks among ICD patients seen in clinical practice.MethodsThis prospective follow-up study included 589 patients with an ICD (mean age = 62.6 ± 10.1 years; 81% men). At baseline, vulnerability for chronic psychological distress was measured by the 14-item Type D (distressed) personality scale. Cox regression models of all-cause and cardiac death were used to examine the importance of risk markers.ResultsAfter a median follow-up of 3.2 years, 94 patients (16%) had died (67 cardiac death), 61 patients (10%) had experienced an appropriate shock and 28 (5%) an inappropriate shock. Inappropriate shocks were not associated with all-cause (p = 0.52) or cardiac (p = 0.99) death. However, appropriate shocks (HR = 2.60, 95% CI 1.47–5.58, p = 0.001) and Type D personality (HR = 1.85, 95% CI 1.12–3.05, p = 0.015) were independent predictors of all-cause mortality, adjusting for age, sex, left ventricular ejection fraction, cardiac resynchronization therapy (CRT), secondary indication, history of coronary artery disease, medication and diabetes. Type D personality and appropriate shocks also independently predicted an increased risk of cardiac death. Other independent predictors of poor prognosis were older age, treatment with CRT and diabetes.ConclusionVulnerability to chronic psychological distress, as defined by the Type D construct, had incremental prognostic value above and beyond clinical characteristics and ICD shocks. Physicians should be aware of chronic psychological distress and device shocks as markers of an increased mortality risk in ICD patients seen in daily clinical practice.Keywords: Implantable cardioverter defibrillator, Mortality, Shocks, Type D personality

AB - BackgroundClinical trials have shown the benefit of implantable cardioverter defibrillator (ICD) treatment. In this study, we examined the importance of chronic psychological distress and device shocks among ICD patients seen in clinical practice.MethodsThis prospective follow-up study included 589 patients with an ICD (mean age = 62.6 ± 10.1 years; 81% men). At baseline, vulnerability for chronic psychological distress was measured by the 14-item Type D (distressed) personality scale. Cox regression models of all-cause and cardiac death were used to examine the importance of risk markers.ResultsAfter a median follow-up of 3.2 years, 94 patients (16%) had died (67 cardiac death), 61 patients (10%) had experienced an appropriate shock and 28 (5%) an inappropriate shock. Inappropriate shocks were not associated with all-cause (p = 0.52) or cardiac (p = 0.99) death. However, appropriate shocks (HR = 2.60, 95% CI 1.47–5.58, p = 0.001) and Type D personality (HR = 1.85, 95% CI 1.12–3.05, p = 0.015) were independent predictors of all-cause mortality, adjusting for age, sex, left ventricular ejection fraction, cardiac resynchronization therapy (CRT), secondary indication, history of coronary artery disease, medication and diabetes. Type D personality and appropriate shocks also independently predicted an increased risk of cardiac death. Other independent predictors of poor prognosis were older age, treatment with CRT and diabetes.ConclusionVulnerability to chronic psychological distress, as defined by the Type D construct, had incremental prognostic value above and beyond clinical characteristics and ICD shocks. Physicians should be aware of chronic psychological distress and device shocks as markers of an increased mortality risk in ICD patients seen in daily clinical practice.Keywords: Implantable cardioverter defibrillator, Mortality, Shocks, Type D personality

U2 - 10.1016/j.ijcard.2012.06.114

DO - 10.1016/j.ijcard.2012.06.114

M3 - Article

VL - 167

SP - 2705

EP - 2709

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

IS - 6

ER -