Type-D personality but not implantable cardioverter-defibrillator indication is associated with impaired health-related quality of life 3 months post-implantation

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Abstract
Aims Little is known about the impact of ICD indication (primary vs. secondary) on health-related quality of life (HRQL). Indication may also interact with psychological factors, such as personality. Using a prospective design, we examined whether ICD indication and type-D personality (i.e. experiencing increased negative emotions paired with emotional non-expression) serve as modulators of HRQL at baseline and 3 months post-implantation. Methods and results Consecutively implanted ICD patients ( n = 154) completed the Type-D Scale (DS14) at baseline and the Short-Form Health Survey 36 (SF-36) at baseline and 3 months. Of all patients, 82 (53%) received an ICD due to prophylactic reasons; the prevalence of type-D was 23%. Indication had no influence on HRQL ( P = 0.75). Further stratification by personality showed a main effect for type-D personality ( P < 0.001), with type-D patients generally experiencing poorer HRQL; there was no main effect for indication ( P = 0.45) nor was the interaction effect indication by type-D significant ( P = 0.22). There was a significant improvement in HRQL over time ( P = 0.001). Type-D remained an independent predictor of impaired HRQL, adjusting for clinical factors and shocks during follow-up ( P < 0.001). However, in adjusted analysis there was no longer a significant change in HRQL over time ( P = 0.099). Conclusion Type-D personality but not ICD indication was associated with impaired HRQL at the time of implantation and at 3 months. In the quest for enhancing risk stratification in clinical practice, personality factors, such as type-D, should not be ignored, as both type-D and poor HRQL have been associated with increased risk of mortality in cardiac patients.