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Failure to Consult for Symptoms of Heart Failure in Patients with a Type-D Personality
  1. Angelique A Schiffer (angelique.schiffer{at}
  1. Tilburg University/TweeSteden Hospital, Netherlands
    1. Johan Denollet (denollet{at}
    1. Tilburg University, Netherlands
      1. Jos W Widdershoven (jwiddershoven{at}
      1. TweeSteden Hospital, Netherlands
        1. Eric H Hendriks (ehendriks{at}
        1. TweeSteden Hospital, Netherlands
          1. Otto R F Smith (r.o.smith{at}
          1. Tilburg University, Netherlands


            Objective Self-management and adequate consultation behaviour are essential for 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 elevated symptom levels and may be at an increased risk for adverse clinical outcomes. We therefore examined whether type-D personality predicts poor self-management and failure to consult for evident cardiac symptoms in CHF.

            Design/Methods/Patients 178 CHF outpatients (ageiÜ80) completed the DS14 (type-D) Scale at baseline, and the Health Complaints Scale (symptoms) and European Heart Failure Self-care Behaviour Scale (self-management) at 2-months follow-up. Medical information was obtained from the patients' medical records.

            Results At follow-up, type-D patients experienced more cardiac symptoms (OR=6.4;95%CI 2.5-16.3, p<.001) and more often appraised these symptoms as worrisome (OR=2.9;95%CI 1.3-6.6, p<.01) as compared to non-type-D patients. Paradoxically, type-D patients 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 1.2-6.0, p<.05), adjusting for demographics, CHF severity/aetiology, time since diagnosis and medication. Accordingly, of 61 CHF patients that failed to consult for evident cardiac symptoms, 43% were type-D (26 patients). Of the remaining 108 CHF patients only 14% (16 patients) had type-D personality.

            Conclusion In conclusion, CHF patients with a type-D personality display inadequate self-management. Failure to consult for symptom elevation may partially explain the adverse effect of type-D personality on cardiac prognosis.

            • Chronic Heart Failure
            • Consultation behaviour
            • Self-management
            • type-D personality

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