Type D personality is a predictor of poor emotional quality of life in primary care heart failure patients independent of depressive symptoms and New York Heart Association functional class

Abstract

Quality of life is an important patient-centered outcome and predictor of mortality in heart failure, but little is known about the role of personality as a determinant of quality of life in this patient group. We examined the influence of Type D personality (i.e., increased negative emotions paired with emotional non-expression) on quality of life in primary care heart failure patients, using a prospective study design. Heart failure patients (n = 251) recruited from 44 primary care practices in Germany completed standardized questionnaires at baseline and 9 months. The prevalence of Type D was 31.9%. Type D patients experienced poorer emotional (P < .001) and physical quality of life (P = .01) at baseline and 9 months compared to non-Type D patients. There was no significant change in emotional (P = .78) nor physical quality of life (P = .74) over time; neither the interaction for time by Type D for emotional (P = .31) nor physical quality of life (P = .91) was significant, indicating that Type D exerted a stable effect on quality of life over time. Adjusting for demographics, New York Heart Association functional class, and depressive symptoms, Type D remained an independent determinant of emotional (P = .03) but not physical quality of life (P = .29). Primary care heart failure patients with a Type D personality experienced poorer emotional but not physical quality of life compared to non-Type D patients. Patients with this personality profile should be identified in primary care to see if their treatment is optimal, as both Type D and poor quality of life have been associated with increased morbidity and mortality.

Fig. 1

Flow chart of study population. * No heart failure (n = 455); terminal illness (n = 24); death (n = 639); patients seen by locums (n = 469); other reasons (n = 1,440: export of electronic patient record incorrect (486), dementia (377), severe psychiatric disease (110)—the remaining patients (467) had either changed domicile or general practitioner or had an urgent need of care, inability to communicate or suffered from cancer). ** Consent to study participation was withdrawn (21), questionnaire not filled in (34), heart failure diagnosis not valid (2), communication problems (2)