Lack of prognostic value of type D personality for mortality in a large sample of heart failure patients

• Published in: Psychosomatic medicine Vol. 73; no. 7; p. 557
• Main Authors: Coyne, James C, Jaarsma, Tiny, Luttik, Marie-Louise, van Sonderen, Eric, van Veldhuisen, Dirk J, Sanderman, Robbert
• Format: Journal Article
• Language: English
• Published: United States 01.09.2011
• Subjects: Aged; Depression - mortality; Depression - physiopathology; Female; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - psychology; Humans; Male; Natriuretic Peptide, Brain - blood; Personality - physiology; Personality Inventory; Prognosis; Proportional Hazards Models; Psychiatric Status Rating Scales
• ISSN: 1534-7796
• DOI: 10.1097/psy.0b013e318227ac75

Type D personality has been proposed as a prognostic indicator for mortality in cardiovascular disease. Most research examining this construct originates from one research group, and it is critical that the predictive value of Type D personality for adverse outcomes is independently cross-validated. This study examined its prognostic value in heart failure, relative to B-type natriuretic peptide (BNP) and depressive symptoms. We studied 706 patients with complete BNP, depressive symptom, and Type D personality and mortality data from 958 patients with heart failure enrolled after hospitalization for a multisite study of a disease management program. Multivariable models were adjusted for BNP and depression. At 18 months, there were 192 deaths (27.2%). No evidence was found for a prognostic value of Type D personality in the unadjusted model (hazard ratio [HR] = 0.893, 95% confidence interval [CI] = 0.582-1.370). In contrast, BNP was significantly predictive of mortality (HR = 1.588, 95% CI = 1.391-1.812), whereas depression was not (HR = 1.011, 95% CI = 0.998-1.024). Type D was also not predictive in covariate-adjusted models (HR = 0.779, 95% CI = 0.489-1.242). Similar results were obtained when analyzing Type D as the interaction between continuous z scores of its two components, negative affectivity and social inhibition (p = .144). In the largest study to date, Type D does not predict mortality. Future research should construe Type D as the interaction of continuous negative affectivity and social inhibition z scores, rather than as a typology, and consider analyses replacing negative affectivity with depression.