Type D Patients Report Poorer Health Status Prior to and After Cardiac Rehabilitation Compared to Non-Type D Patients
Type D personality is an emerging risk factor in coronary artery disease (CAD). Cardiac rehabilitation (CR) improves outcomes, but little is known about the effects of CR on Type D patients.
We examined (1) variability in Type D caseness following CR, (2) Type D as a determinant of health status, and (3) the clinical relevance of Type D as a determinant of health status compared to cardiac history.
CAD patients (n = 368) participating in CR completed the Type D Scale, the Short-Form Health Survey 36 pre- and post-CR, and the Hospital Anxiety and Depression Scale pre-CR, to assess health status and depressive and anxious symptomatology, respectively.
The prevalence of Type D decreased from 26.6% to 20.7% (p = 0.012) following CR, but Type D caseness remained stable in 81% of patients. Health status significantly improved following CR [F(1,359) = 17.48, p < 0.001], adjusting for demographic and clinical factors and anxious and depressive symptoms. Type D patients reported poorer health status [F(1,359) = 10.40, p = 0.001], with the effect of Type D being stable over time [F(1,359) = 0.49, p = 0.48]. Patients with a cardiac history benefited less from CR [F(1,359) = 5.76, p = 0.02]. The influence of Type D on health status was larger compared to that for cardiac history, as indicated by Cohen’s effect size index.
Type D patients reported poorer health status compared to non-Type D patients pre- and post-CR. In the majority of patients, CR did not change Type D caseness, with Type D being associated with a stable and clinically relevant effect on outcome. These high-risk patients should be identified in clinical practice and may require adjunctive interventions.
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- Type D Patients Report Poorer Health Status Prior to and After Cardiac Rehabilitation Compared to Non-Type D Patients
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Annals of Behavioral Medicine
Volume 36, Issue 2 , pp 167-175
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- Cardiac rehabilitation
- Coronary artery disease
- Health status
- Type D personality
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- Author Affiliations
- 1. CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
- 2. Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- 3. Department of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
- 4. Rotterdam Organization for Cardiac Rehabilitation, Rotterdam, The Netherlands