Ann Rehabil Med.  2018 Oct;42(5):748-757. 10.5535/arm.2018.42.5.748.

Effect of Type D Personality on Short-Term Cardiac Rehabilitation in Patients With Coronary Artery Disease

• Lee SJ
• Koh S
• Kim BO
• Kim B
• Kim C

• KMID: 2429204
• DOI: http://doi.org/10.5535/arm.2018.42.5.748

Abstract

OBJECTIVE
To investigate the effect of type D personality on cardiac rehabilitation (CR) participation rates and the effect of a short-term CR program.
METHODS
Study participants included patients diagnosed with acute coronary syndrome who underwent percutaneous coronary intervention. Patients completed the Type D personality Scale (DS-14) and the Hospital Anxiety and Depression Scale (HADS) at program entry. Subjects were recommended participation in 6 weeks of CR exercise training. Cardiopulmonary exercise test (CPET) was conducted before and after completion of the training. CR participation refers to completion of the 6-week CR exercise program and performance of the secondary CPET. Drop-out refers to the subjects who were unable to participate in the 6-week CR exercise program or to perform the secondary CPET.
RESULTS
At baseline, type D personality was evident in 21 of 63 patients (33.3%). Type D patients were more often depressed (57.1%) and anxious (38.1%) than non-type D patients (31.0% and 9.5%, respectively). At baseline, participants with type D personality showed a decreased body mass index (24.6 vs. 26.1 kg/m², p=0.025). The type D group displayed a lower CR participation rate (5/21, 23.8%) compared with the non-type D group of (22/42, 52.4%). Logistic regression analysis revealed the association of type D personality with CR drop-out rate (odds ratio=3.87; 95% confidence interval, 1.2-12.5; p < 0.05).
CONCLUSION
Type D personality was independently associated with drop-out from CR program and with significantly higher levels of anxiety and depressive mood.

Keyword

Cardiac rehabilitation; Coronary artery disease; Exercise test; Type D personality

MeSH Terms

Acute Coronary Syndrome
Anxiety
Body Mass Index
Coronary Artery Disease*
Coronary Vessels*
Depression
Exercise Test
Humans
Logistic Models
Percutaneous Coronary Intervention
Rehabilitation*
Type D Personality*

Figure

• 

  Fig. 1. Flow diagram outlining progress of subjects in the study. CR, cardiac rehabilitation; CPET, cardiopulmonary exercise test.

Reference

1. McCranie EW, Watkins LO, Brandsma JM, Sisson BD. Hostility, coronary heart disease (CHD) incidence, and total mortality: lack of association in a 25-year follow-up study of 478 physicians. J Behav Med. 1986; 9:119–25.

2. Pedersen SS, Denollet J, Ong AT, Serruys PW, Erdman RA, van Domburg RT. Impaired health status in Type D patients following PCI in the drug-eluting stent era. Int J Cardiol. 2007; 114:358–65.

3. Watson D, Pennebaker JW. Health complaints, stress, and distress: exploring the central role of negative affectivity. Psychol Rev. 1989; 96:234–54.

4. Pedersen SS, Middel B. Increased vital exhaustion among type-D patients with ischemic heart disease. J Psychosom Res. 2001; 51:443–9.

5. Thompson PD, Arena R, Riebe D, Pescatello LS; American College of Sports Medicine. ACSM’s new preparticipation health screening recommendations from ACSM’s guidelines for exercise testing and prescription, ninth edition. Curr Sports Med Rep. 2013; 12:215–7.

6. Kim C, Kim YJ. The effects of Karvonen exercise prescription in acute coronary artery disease patients reaching age-predicted maximal heart rates with exercise stress test. J Exp Biomed Sci. 2013; 19:254–60.

7. Karvonen MJ, Kentala E, Mustala O. The effects of training on heart rate: a longitudinal study. Ann Med Exp Biol Fenn. 1957; 35:307–15.

8. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation. 2001; 104:1694–740.

9. Lee MS, Park YM, Lim HE, Song WH, Ahn JC, Kim SH, et al. Preliminary study on the standardization of Korean version of type D personality scale 14: internal consistency and construct validity. Korean J Psychosom Med. 2007; 15:81–7.

10. Denollet J. DS14: standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosom Med. 2005; 67:89–97.

11. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67:361–70.

12. Oh SM, Min KJ, Park DB. A study on the standardization of the hospital anxiety and depression scale for Koreans: a comparison of normal, depressed and anxious groups. J Korean Neuropsychiatr Assoc. 1999; 38:289–96.

13. Hemingway H, Marmot M. Evidence based cardiology: psychosocial factors in the aetiology and prognosis of coronary heart disease. Systematic review of prospective cohort studies. BMJ. 1999; 318:1460–7.

14. Pedersen SS, Holkamp PG, Caliskan K, van Domburg RT, Erdman RA, Balk AH. Type D personality is associated with impaired health-related quality of life 7 years following heart transplantation. J Psychosom Res. 2006; 61:791–5.

15. Aquarius AE, Denollet J, Hamming JF, De Vries J. Role of disease status and type D personality in outcomes in patients with peripheral arterial disease. Am J Cardiol. 2005; 96:996–1001.

16. Pedersen SS, van Domburg RT, Theuns DA, Jordaens L, Erdman RA. Type D personality is associated with increased anxiety and depressive symptoms in patients with an implantable cardioverter defibrillator and their partners. Psychosom Med. 2004; 66:714–9.

17. Denollet J, Pedersen SS, Vrints CJ, Conraads VM. Usefulness of type D personality in predicting five-year cardiac events above and beyond concurrent symptoms of stress in patients with coronary heart disease. Am J Cardiol. 2006; 97:970–3.

18. Sogaro E, Schinina F, Burgisser C, Orso F, Pallante R, Aloi T, et al. Type D personality impairs quality of life, coping and short-term psychological outcome in patients attending an outpatient intensive program of cardiac rehabilitation. Monaldi Arch Chest Dis. 2010; 74:181–91.

19. Cao X, Wong EM, Chow Choi K, Cheng L, Ying Chair S. Interventions for cardiovascular patients with Type D personality: a systematic review. Worldviews Evid Based Nurs. 2016; 13:314–23.

20. Kupper N, Pedersen SS, Hofer S, Saner H, Oldridge N, Denollet J. Cross-cultural analysis of type D (distressed) personality in 6222 patients with ischemic heart disease: a study from the International HeartQoL Project. Int J Cardiol. 2013; 166:327–33.

21. Vukovic O, Tosevski DL, Jasovic-Gasic M, Damjanovic A, Zebic M, Britvic D, et al. Type D personality in patients with coronary artery disease. Psychiatr Danub. 2014; 26:46–51.

22. Yu XN, Chen Z, Zhang J, Liu X. Coping mediates the association between Type D personality and perceived health in Chinese patients with coronary heart disease. Int J Behav Med. 2011; 18:277–84.

23. Park JH, Tahk SJ, Bae SH. Impact of type D personality on health status and health behaviors in patients with coronary artery disease. Korean J Health Promot. 2010; 10:123–30.

24. Son HM. Quality of life and illness intrusiveness by type-D personality in the patients with coronary artery disease. J Korean Acad Nurs. 2009; 39:349–56.

25. Svansdottir E, Denollet J, Thorsson B, Gudnason T, Halldorsdottir S, Gudnason V, et al. Association of type D personality with unhealthy lifestyle, and estimated risk of coronary events in the general Icelandic population. Eur J Prev Cardiol. 2013; 20:322–30.

26. Versteeg H, Spek V, Pedersen SS, Denollet J. Type D personality and health status in cardiovascular disease populations: a meta-analysis of prospective studies. Eur J Prev Cardiol. 2012; 19:1373–80.

27. Hausteiner C, Klupsch D, Emeny R, Baumert J, Ladwig KH; KORA Investigators. Clustering of negative affectivity and social inhibition in the community: prevalence of type D personality as a cardiovascular risk marker. Psychosom Med. 2010; 72:163–71.

28. Starrenburg AH, Kraaier K, Pedersen SS, van Hout M, Scholten M, van der Palen J. Association of psychiatric history and type D personality with symptoms of anxiety, depression, and health status prior to ICD implantation. Int J Behav Med. 2013; 20:425–33.

29. Svansdottir E, van den Broek KC, Karlsson HD, Gudnason T, Denollet J. Type D personality is associated with impaired psychological status and unhealthy lifestyle in Icelandic cardiac patients: a cross-sectional study. BMC Public Health. 2012; 12:42.

30. Pedersen SS, Denollet J, van Gestel YR, Serruys PW, van Domburg RT. Clustering of psychosocial risk factors enhances the risk of depressive symptoms 12-months post percutaneous coronary intervention. Eur J Cardiovasc Prev Rehabil. 2008; 15:203–9.

31. Williams L, O’Connor RC, Howard S, Hughes BM, Johnston DW, Hay JL, et al. Type-D personality mechanisms of effect: the role of health-related behavior and social support. J Psychosom Res. 2008; 64:63–9.

32. Pedersen SS, Schiffer AA. The distressed (Type D) personality: a risk marker for poor health outcomes in ICD patients. Herzschrittmacherther Elektrophysiol. 2011; 22:181–8.

33. Pelle AJ, Erdman RA, van Domburg RT, Spiering M, Kazemier M, Pedersen SS. Type D patients report poorer health status prior to and after cardiac rehabilitation compared to non-type D patients. Ann Behav Med. 2008; 36:167–75.

34. Denollet J, Schiffer AA, Spek V. A general propensity to psychological distress affects cardiovascular outcomes: evidence from research on the type D (distressed) personality profile. Circ Cardiovasc Qual Outcomes. 2010; 3:546–57.

35. Pedersen SS, Denollet J. Is Type D personality here to stay? Emerging evidence across cardiovascular disease patient groups. Curr Cardiol Rev. 2006; 2:205–13.

36. Whitehead DL, Perkins-Porras L, Strike PC, Magid K, Steptoe A. Cortisol awakening response is elevated in acute coronary syndrome patients with type-D personality. J Psychosom Res. 2007; 62:419–25.

37. Habra ME, Linden W, Anderson JC, Weinberg J. Type D personality is related to cardiovascular and neuroendocrine reactivity to acute stress. J Psychosom Res. 2003; 55:235–45.

38. Mommersteeg PM, Pelle AJ, Ramakers C, Szabo BM, Denollet J, Kupper N. Type D personality and course of health status over 18 months in outpatients with heart failure: multiple mediating inflammatory biomarkers. Brain Behav Immun. 2012; 26:301–10.

39. Altmaier E, Emeny RT, Krumsiek J, Lacruz ME, Lukaschek K, Hafner S, et al. Metabolomic profiles in individuals with negative affectivity and social inhibition: a population-based study of Type D personality. Psychoneuroendocrinology. 2013; 38:1299–309.

40. Pelle AJ, Schiffer AA, Smith OR, Widdershoven JW, Denollet J. Inadequate consultation behavior modulates the relationship between type D personality and impaired health status in chronic heart failure. Int J Cardiol. 2010; 142:65–71.