Journal of Behavioral Medicine

, Volume 34, Issue 1, pp 13–22

Predictors of readmission and health related quality of life in patients with chronic heart failure: a comparison of different psychosocial aspects

  • Andreas Volz
  • Jean-Paul Schmid
  • Marcel Zwahlen
  • Sonja Kohls
  • Hugo Saner
  • Jürgen Barth
Article

Abstract

Psychological distress is common in patients with chronic heart failure. The impact of different psychological variables on prognosis has been shown but the comparative effects of these variables remain unclear. This study examines the impact of depression, anxiety, vital exhaustion, Type D personality, and social support on prognosis in chronic heart failure patients. One hundred eleven patients (mean age 57 ± 14 years) having participated in an exercise based ambulatory cardiac rehabilitation program were enrolled in a prospective cohort study. Psychological baseline data were assessed at program entry. Mortality, readmission, and health-related quality of life were assessed at follow up (mean 2.8 ± 1.1 years). After controlling for disease severity none of the psychological variables were associated with mortality, though severe anxiety predicted readmission [HR = 3.21 (95% CI, 1.04–9.93; P = .042)]. Health-related quality of life was independently explained by vital exhaustion, anxiety and either body mass index (physical dimension) or sex (emotional dimension). As psychological variables have a strong impact on health-related quality of life they should be routinely assessed in chronic heart failure patients` treatment.

Keywords

Psychological stress Depression Anxiety Heart failure Mortality Quality of life 

References

  1. Appels, A. (2004). Exhaustion and coronary heart disease: The history of a scientific quest. Patient Education and Counseling, 55, 223–229.CrossRefPubMedGoogle Scholar
  2. Appels, A., Höppener, P., & Mulder, P. (1987). A questionnaire to assess premonitory symptoms of myocardial infarction. International Journal of Cardiology, 17, 15–24.CrossRefPubMedGoogle Scholar
  3. Barth, J., Schneider, S., & von Känel, R. (2010). Lack of social support in the etiology and prognosis of coronary heart disease: A systematic review and meta-analysis. Psychosomatic Medicine, 72, 229–238.CrossRefPubMedGoogle Scholar
  4. Bennett, S. J., Perkins, S. M., Lane, K. A., Deer, M., Brater, D. C., & Murray, M. D. (2001). Social support and health-related quality of life in chronic heart failure patients. Quality of Life Research, 10, 671–682.CrossRefPubMedGoogle Scholar
  5. Bortz, J. (Ed.). (2000). Statistik für Sozialwissenschaftler. Berlin: Springer-Verlag.Google Scholar
  6. Carels, R. A. (2004). The association between disease severity, functional status, depression and daily quality of life in congestive heart failure patients. Quality of Life Research, 13, 63–72.CrossRefPubMedGoogle Scholar
  7. Carini, F., Nicolucci, A., Ciampi, A., Labbrozzi, D., Bettinardi, O., Zotti, A., et al. (1997). Role of interactions between psychological and clinical factors in determining 6-month mortality among patients with acute myocardial infarction. Application of recursive partitioning techniques to the GISSI-2 database. Gruppo Italiano per lo Studio della Sopravvivenza nell`Infarto Miocardio. European Heart Journal, 18, 835–845.Google Scholar
  8. Chung, M. L., Moser, D. K., Lennie, T. A., & Rayens, M. K. (2009). The effects of depressive symptoms and anxiety on quality of life with heart failure and their spouses: Testing dyadic dynamics using actro-partner interdependence model. Journal of Psychosomatic Research, 67, 29–35.CrossRefPubMedGoogle Scholar
  9. Coyne, J. (2001). Prognostic importance of martial quality for survival of congestive heart failure. The American Journal of Cardiology, 88, 526–529.CrossRefPubMedGoogle Scholar
  10. Denollet, J. (2005). DS14: Standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosomatic Medicine, 67, 89–97.CrossRefPubMedGoogle Scholar
  11. Faller, H., Steinbüchel, T., Störk, S., Schowalter, M., Ertl, G., & Angermann, C. E. (2010). Impact of depression on quality of life assessment in heart failure. International Journal of Cardiology, 142, 133–137.CrossRefPubMedGoogle Scholar
  12. Faller, H., Störk, S., Schowalter, M., Steinbüchel, T., Wollner, V., Ert, G., et al. (2007). Depression and survival in chronic heart failure: Does gender play a role? European Journal of Heart Failure, 9, 1018–1023.CrossRefPubMedGoogle Scholar
  13. Friedmann, E., Thomas, S. A., Liu, F., Morton, P. G., Chapa, D., & Gottlieb, S. (2006). Sudden cardiac death in heart failure trial investigators. Relationship of depression, anxiety, and social isolation to chronic heart failure outpatient mortality. American Heart Journal, 152, e1–e8.CrossRefPubMedGoogle Scholar
  14. Gottlieb, S. S., Khatta, M., & Friedmann, E. (2004). The influence of age, gender, and race on the prevalence of depression in heart failure patients. Journal of the American College of Cardiology, 43, 1542–1549.CrossRefPubMedGoogle Scholar
  15. Grande, G., Jordan, J., Kümmel, M., Struwe, C., Schubmann, R., Schulze, F., et al. (2004). Evaluation of the German Type D Scale (DS14) and prevalence of the Type D personality pattern in cardiological and psychosomatic patients and healthy subjects. Psychotherapie, Psychosomatik, Medizinische Psychologie, 54, 413–422.CrossRefPubMedGoogle Scholar
  16. Hair, J. F., Black, W. C., Babin, B. J., Anderson, R. E., & Tatham, R. L. (Eds.). (2006). Multivariate data analysis (6th ed.). New Jersey: Pearson Prentice Hall.Google Scholar
  17. Herrmann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale: A review of validation data and clinical results. Journal of Psychosomatic Research, 42, 17–41.CrossRefPubMedGoogle Scholar
  18. Herrmann, C., Buss, U., & Snaith, R. P. (1995). HADS-D Hospital Anxiety and Depression Scale Deutsche version. Ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin. Bern: Verlag Hans Huber.Google Scholar
  19. Jiang, W., Alexander, J., Cristopher, E., Kuchibhatla, M., Galden, L. H., Cuffe, M., et al. (2001). Relationship of depression to increased risk of mortality and rehospitalisation in patients with congestive heart failure. Archives of Internal Medicine, 161, 1849–1856.CrossRefPubMedGoogle Scholar
  20. Jiang, W., Kuchibhatla, M., Cuffe, M., Cristopher, F., Alexander, J., Clary, G., et al. (2004). Prognostic value of anxiety and depression in patients with chronic heart failure. Circulation, 110, 3452–3456.CrossRefPubMedGoogle Scholar
  21. Juenger, J., Schellberg, D., Kraemer, S., Haunstetter, A., Zugck, C., Herzog, W., et al. (2008). Health related quality of life in patients with congestive heart failure: Comparison with other chronic diseases and relation to functional variables. Heart, 87, 235–241.CrossRefGoogle Scholar
  22. Juenger, J., Schellberg, D., Müller-Tasch, T., Raupp, G., Zugck, C., Haunstetter, A., et al. (2005). Depression increasingly predicts mortality in the course of congestive heart failure. The European Journal of Heart Failure, 7, 261–267.CrossRefGoogle Scholar
  23. Katon, W. D., Lin, E. H. B., & Kroenke, K. (2007). The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. General Hospital Psychiatry, 29, 147–155.CrossRefPubMedGoogle Scholar
  24. Knoll, N., & Kienle, R. (2007). Self-report questionnaires for the assessment of social support: An overview. Zeitschrift für Medizinische Psychologie, 16, 57–71.Google Scholar
  25. Kudielka, B. M., Känel, R., von Preckl, D., Lilian, Z., Mischler, K., & Fischer, J. E. (2006). Exhaustion is associated with reduced habituation of free cortisol response to repeated acute psychosocial stress. Biological Psychology, 72, 147–153.CrossRefPubMedGoogle Scholar
  26. Kudielka, B. M., von Känel, R., Gander, M.-L., & Fischer, J. E. (2004). The interrelationship of psychological risk factors for coronary artery disease in a working population: Do we measure distinct or overlapping psychological concepts? Behavioral Medicine, 30, 35–44.CrossRefPubMedGoogle Scholar
  27. Lane, D., Caroll, D., Ring, C., Beevers, D. G., & Lip, G. H. Y. (2001). Mortality and quality of life 12 months after myocardial infarction: Effects of depression and anxiety. Psychosomatic Medicine, 63, 221–230.PubMedGoogle Scholar
  28. Lloyd-Jones, D., Adams, R., Carnethon, M., De Simone, G., Ferguson, T. B., Flegal, K., et al. (2009). Heart disease and stroke statistics 2009 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittees. Circulation, 119, 480–486.CrossRefPubMedGoogle Scholar
  29. Luttik, M. L., Jaarsma, T., Moser, D., Sanderman, R., & van Veldhuisen, D. J. (2005). The importance and impact of social support on outcomes in patients with heart failure: An overview of the literature. Journal of Cardiovascular Nursing, 20, 162–169.PubMedGoogle Scholar
  30. Mahadevan, G., Davis, R. C., Frenneaux, M. P., Hobbs, F. D. R., Lip, G. H. Y., Sanderson, J. E., et al. (2008). Left ventricular ejection fraction: Are the revised cut-off points for defining systolic dysfunction sufficiently evidence based? Heart, 94, 426–428.CrossRefPubMedGoogle Scholar
  31. Mancini, D., Lejemtel, T., & Aaronson, K. (2000). Peak VO2 a simple yet enduring standard. Circulation, 101, 1152–1157.Google Scholar
  32. Martens, E. J., Kupper, N., Pedersen, S. S., Aquarius, A. E., & Denollet, J. (2007). Type-D personality is a stable taxonomy in post-MI patients over an 18-month period. Journal of Psychosomatic Research, 63, 545–550.CrossRefPubMedGoogle Scholar
  33. Mitchell, P. H., Rowell, L., Blumenthal, J., Norten, J., Ironson, G., Pitula, C. R., et al. (2003). A short social support measure for patients recovering from myocardial infarction: The enriched social support inventory. Journal of Cardiopulmonary Rehabilitation, 23, 398–403.CrossRefPubMedGoogle Scholar
  34. Mosterd, A., Cost, B., Hoes, A. W., de Bruijne, M. C., Deckser, J. W., Hofman, A., et al. (2001). The prognosis of heart failure in the general population. European Heart Journal, 22, 1318–1327.CrossRefPubMedGoogle Scholar
  35. Müller-Tasch, T., Peters-Klimm, F., Schellberg, D., Holzapfel, N., Barth, A., Jünger, J., et al. (2007). Depression is a major determinant of quality of life in patients with chronic systolic heart failure in general practice. Journal of Cardiac Failure, 13, 818–824.CrossRefPubMedGoogle Scholar
  36. Muntwyler, J., Abetel, G., Gruner, C., & Follath, F. (2002). One year mortality among unselected outpatients with heart failure. European Heart Journal, 23, 1861–1866.CrossRefPubMedGoogle Scholar
  37. Murberg, T. A., & Bru, E. (2001). Social relationships and mortality in patients with congestive heart failure. Journal of Psychosomatic Research, 51, 521–527.CrossRefPubMedGoogle Scholar
  38. Pelle, A. J. M., Gidron, Y. Y., Balazs, M. S., & Denollet, J. (2008). Psychological predictors of prognosis in chronic heart failure. Journal of Cardiac Failure, 14, 341–350.CrossRefPubMedGoogle Scholar
  39. Pocock, S. J., Wang, D., Pfeffer, M. A., Yusuf, S., McMurray, J. J., Swedberg, K. B., et al. (2006). Predictors of mortality and morbidity in patients with chronic heart failure. European Heart Journal, 27, 65–75.CrossRefPubMedGoogle Scholar
  40. Quittan, M., Wiesinger, G. F., Crevenna, R., Nuhr, M. J., Posch, M., Hülsmann, M., et al. (2001). Cross-cultural adaptation of the Minnesota living with heart failure questionnaire for german-speaking patients. Journal of Rehabilitation in Medicine, 33, 182–186.CrossRefGoogle Scholar
  41. Rector, T. S., Kubo, S. H., & Cohn, J. (1987). Patient`s self-assessment of their congestive heart failure: Content, reliability, and validity of a new measure: The minnesota living with heart failure questionnaire. Heart Failure, 3, 198–219.Google Scholar
  42. Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H., & Mills, P. J. (2006). Depression in heart failure: A meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. Journal of the American College of Cardiology, 48, 1527–1537.CrossRefPubMedGoogle Scholar
  43. Schiffer, A., Pederson, S. S., Widdershoven, J. W., Hendriks, E. H., Winter, J. B., & Denollet, J. (2005). The distressed (Type D) personality is independently associated with impaired health status and increased depressive symptoms in chronic heart failure. European Journal of Cardiovascular Prevention and Rehabilitation, 12, 341–346.CrossRefPubMedGoogle Scholar
  44. Schiffer, A., Smith, O. R. F., Pedersen, S. S., Widdershoven, J. W., Denollet, J. (2010). Type D personality and cardiac mortality in patients with chronic heart failure. International Journal of Cardiology, 142, 230–235.Google Scholar
  45. Schnorpfeil, P., Noll, A., Wirtz, P., Schulze, R., Ehlert, U., Frey, K., et al. (2002). Assessment of exhaustion and related risk factors in employees in the manufacturing industry: A cross-sectional study. International Archives of Occupational and Environmental Health, 75, 535–540.CrossRefPubMedGoogle Scholar
  46. Smith, O. R. F., Gidron, Y. Y., Kupper, N., Winter, J. B., & Denollet, J. (2009). Vital exhaustion in chronic heart failure: Symptom profiles and clinical outcome. Journal of Psychosomatic Research, 66, 195–201.CrossRefPubMedGoogle Scholar
  47. Song, E. K., Lennie, T. A., & Moser, D. K. (2009). Depressive symptoms increase risk of rehospitalisation in heart failure patients with preserved systolic function. Journal of Clinical Nursing, 18, 1871–1877.CrossRefPubMedGoogle Scholar
  48. Stelken, A. M., Younis, L. T., Jennison, S. H., Miller, D. D., Miller, L. W., Shaw, L. J., et al. (1996). Prognostic value of cardiopulmonary exercise testing using percent of predicted peak oxygen uptake for patients with ischemic and dilated cardiomyopathy. Journal of the American College of Cardiology, 27, 345–352.CrossRefPubMedGoogle Scholar
  49. Strömberg, A., Broström, A., Dahlström, U., & Friedlund, B. (1999). Factors influencing patient compliance with therapeutic regimens in chronic heart failure: A critical incident technique analysis. Heart & Lung: the Journal of Critical Care, 28, 334–341.CrossRefGoogle Scholar
  50. Suls, J., & Bunde, J. (2005). Anger, anxiety, and depression as risk factors for cardiovascular disease: The problems and implications of overlapping affective dispositions. Psychological Bulletin, 13, 260–300.CrossRefGoogle Scholar
  51. Vaglio, J., Conard, M., Poston, W., O’Keefe, J., Haddock, C. K., House, J., et al. (2004). Testing the performance of the ENRICHD social support instrument in cardiac patients. Health and Quality of Life Outcomes, 2, 24.CrossRefPubMedGoogle Scholar
  52. Zigmond, A. S., & Snaith, R. P. (1987). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Andreas Volz
    • 1
  • Jean-Paul Schmid
    • 2
  • Marcel Zwahlen
    • 3
  • Sonja Kohls
    • 2
  • Hugo Saner
    • 2
  • Jürgen Barth
    • 1
  1. 1.Division of Social and Behavioral Health Research, Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
  2. 2.Cardiovascular Prevention and Rehabilitation, Swiss Cardiovascular Center Bern, Bern University HospitalUniversity of BernBernSwitzerland
  3. 3.Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland

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