Heart 93:814-818 doi:10.1136/hrt.2006.102822
  • Original research

Failure to consult for symptoms of heart failure in patients with a type-D personality

  1. Angélique A Schiffer1,
  2. Johan Denollet1,
  3. Jos W Widdershoven2,
  4. Eric H Hendriks2,
  5. Otto R F Smith1
  1. 1Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
  2. 2Department of Cardiology, TweeSteden Hospital, Tilburg, The Netherlands
  1. Correspondence to:
    MA AA Schiffer
    Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands; angelique.schiffer{at}
  • Accepted 14 November 2006
  • Published Online First 7 March 2007


Background: Self-management and adequate consultation behaviour are essential for the successful treatment of chronic heart failure (CHF). Patients with a type-D personality, characterised by high social inhibition and negative affectivity, may delay medical consultation despite increased symptom levels and may be at an increased risk for adverse clinical outcomes.

Aim: To examine whether type-D personality predicts poor self-management and failure to consult for evident cardiac symptoms in patients with CHF.

Design/methods/patients: 178 outpatients with CHF (aged ⩽80 years) completed the type-D Personality Scale at baseline, and the Health Complaints Scale (symptoms) and European Heart Failure Self-care Behaviour Scale (self-management) at 2 months of follow-up. Medical information was obtained from the patients’ medical records.

Results: At follow-up, patients with a type-D personality experienced more cardiac symptoms (OR 6.4; 95% CI 2.5 to 16.3, p<0.001) and more often appraised these symptoms as worrisome (OR 2.9; 95% CI 1.3 to 6.6, p<0.01) compared with patients with a non-type-D personality. Paradoxically, patients with a type-D personality were less likely to report these symptoms to their cardiologist/nurse, as indicated by an increased risk for inadequate consultation behaviour (OR 2.7; 95% CI 1.2 to 6.0, p<0.05), adjusting for demographics, CHF severity/aetiology, time since diagnosis and medication. Accordingly, of 61 patients with CHF who failed to consult for evident cardiac symptoms, 43% had a type-D personality (n = 26). Of the remaining 108 patients with CHF, only 14% (n = 16) had a type-D personality.

Conclusion: Patients with CHF with a type-D personality display inadequate self-management. Failure to consult for increased symptom levels may partially explain the adverse effect of type-D personality on cardiac prognosis.


  • Published Online First 7 March 2007

  • Funding: This study was supported by grants from Medtronic, St Jude Medical and the Netherlands Heart Foundation (#2003B038).

  • Competing interests: None declared.