Health status in patients treated with cardiac resynchronization therapy: modulating effects of personality.

BACKGROUND Cardiac resynchronization therapy (CRT) is a promising treatment in chronic heart failure (CHF). However, a subgroup of patients still report impaired health status, cardiac symptoms, and feelings of disability following CRT. The aims of this study were to examine (1) whether CHF patients treated with CRT improved in patient-centered outcomes and functional capacity, and (2) whether personality traits exert a stable effect on these outcomes over two months. METHODS Analyses are based on 31 patients (65% male; mean age 70 +/- 8) with CHF treated with CRT. Two weeks before and two months after CRT, patients completed the Type-D Scale (negative affectivity, i.e., tendency to experience negative emotions, and social inhibition, i.e., tendency to inhibit self-expression), the Minnesota Living with Heart Failure Questionnaire (disease-specific health status), and the Health Complaints Scale (cardiac symptoms and perceived disability), and performed the six-minute walking test (functional capacity). RESULTS There was an improvement in disease-specific health status (P< 0.001), cardiac symptoms (P = 0.001), perceived disability (P< 0.001), and functional capacity (P = 0.007) in all patients over two months. However, high negative affectivity patients reported significantly lower disease-specific health status (P = 0.046), and more cardiac symptoms (P = 0.035), and perceived disability (P = 0.015) as compared to low negative affectivity patients. There was no significant main effect for negative affectivity on functional capacity. High negative affectivity patients still reported lower disease-specific health status (P = 0.06) and significantly more perceived disability (P = 0.04) when adjusting for left ventricular ejection fraction, gender, and age. The effects of negative affectivity on patient-centered outcomes, as measured by Cohen's effect size index, were moderate to large. CONCLUSIONS Patient-centered outcomes improved over a two-month period in patients treated with CRT, but negative affectivity exerted a stable, negative effect on health status, cardiac symptoms, and perceived disability. Personality traits should be taken into account when evaluating effects of CRT.