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Biomedical subjects

J Denollet

Publications and source records attributed to J Denollet.

At least 19 recordsLinked to original sources
PubMed2005

Impaired health status and invasive treatment in peripheral arterial disease: a prospective 1-year follow-up study.

OBJECTIVE: It has been argued that health status and quality of life (QOL) should be taken into account in the treatment policy of patients with peripheral arterial disease (PAD). In cardiac patients, it has been shown that poor perceived health status is an independent predictor of mortality and hospitalization. We therefore examined (1) the role of health status, QOL, and clinical indices of disease severity as determinants of invasive treatment in patients with PAD and (2) the effect of invasive treatment on health status and QOL. METHODS: At their first visit, patients completed the RAND 36-item Health Survey and World Health Organization Quality of Life assessment instrument questionnaires to assess health status and QOL, respectively. During the 1-year follow-up period, data concerning hospitalization were derived from the patients' medical files. Furthermore, patients completed the RAND 36 and the World Health Organization Quality of Life assessment instrument again at 1-year follow-up. The setting was a vascular outpatient clinic of a teaching hospital in Tilburg, The Netherlands; participants were 200 consecutive patients newly diagnosed with intermittent claudication, a common expression of PAD. Diagnosis was based on history, physical examination, treadmill walking distance, and ankle-brachial pressure indices. Main outcome measures were (1) invasive treatment of PAD that took place during the 1-year follow-up, derived from the patients' medical files, and (2) health status and QOL after 1 year of follow-up. RESULTS: After 1 year of follow-up, 107 patients (53.5%) were event free, whereas 77 patients (38.5%) had been hospitalized for invasive treatment of PAD. Sixteen patients (8%) were hospitalized for other cardiovascular reasons. In a multivariate logistic regression model, age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.91-0.99; P = .024), pain-free walking distance (OR, 2.74; 95% CI, 1.05-7.17; P = .04), and physical functioning (OR, 4.46; 95% CI, 1.79-11.12; P = .001) were independent predictors of invasive treatment of intermittent claudication. After 1 year of follow-up, patients who were treated invasively experienced a significant improvement in their physical functioning ( P = .004), role limitations due to emotional problems ( P = .018), and bodily pain ( P = .026). CONCLUSIONS: Patients with poor self-reported physical functioning, limited walking distance, and a younger age were likely to be treated invasively. The physician's clinical judgment about when to intervene adequately reflects the patient's own opinion about his or her health status. Invasive treatment led to a significant improvement in patients' health status. These findings indicate the effectiveness of the strategy to include patients' perceived physical functioning into the process of clinical decision-making.

Adult↗
PubMed2004

Men deny and women cry, but who dies? Do the wages of "denial" include early ischemic coronary heart disease?

OBJECTIVES: In this study patients with documented ischemic coronary heart disease (ICHD; prior MI or CAD per catheterization) were tested for the association of various measures of emotional distress with Age at Initial Diagnosis. METHODS: The measures were chosen because of a published track record at predicting mortality in this population. Females were oversampled to achieve equivalent numbers of each sex (n=50), and thus equivalent statistical power. In a subset of patients (38 males and 32 females), Spouse/Friend Ketterer Stress Symptom Frequency Checklists (KSSFCs) were received. RESULTS: Females reported more depression and anxiety than males. However, spouses or friends reported more anger for males. Denial (spouse/friend minus self-ratings) was greater in males for all three scales of the KSSFC (Anger, P=.005; Depression, P=.024; Anxiety, P=.001). Although females showed the same trend, self and spouse or friend ratings of distress were significantly associated with Age at Initial Diagnosis only in males. When split at the sample mean on the Spouse/Friend KSSFC AIAI (Anger) scale, Age at Initial Diagnosis occurred 14.2 years earlier in males. CONCLUSIONS: Use of a significant other in assessing psychosocial/emotional distress in males may confer greater accuracy, and therefore predictive power for clinical endpoints.

Coronary Disease↗
PubMed2002

Perceived health following myocardial infarction: cross-validation of the Health Complaints Scale in Danish patients.

With an ageing population and a decline in cardiac mortality rates, the number of patients with cardiac disease is increasing, which in turn poses a major challenge for secondary prevention. For this end, appropriate, sensitive, and validated instruments to assess health complaints and quality of life are required. The objectives of the current study were: (1) to cross-validate the Health Complaints Scale (HCS) in a Danish sample of patients with a first myocardial infarction (MI); and (2) to investigate whether perceived health, as measured by the HCS is related to cardiac disease severity. The HCS was originally developed in Belgian patients with coronary artery disease. One-hundred-and-twelve consecutive patients with a first myocardial infarction were assessed by means of a questionnaire four to six weeks post infarction. Clinical measures were sampled from medical records. The factor structure of the HCS and the internal consistency of the Somatic Complaints (alpha = 0.91) and Cognitive Complaints subscales (alpha = 0.94) were confirmed. The construct validity of the scale was confirmed against measures of psychopathology and personality. Patients scored significantly higher on the HCS Somatic and Cognitive scales as compared with self-reports of depression and anxiety (p < 0.0001). Health complaints were unrelated to severity of cardiac disease and rather reflected subjective perception of quality of life. These findings show that the HCS is a valid instrument that is equally applicable in Danish cardiac patients to monitor perceived health as a major component of quality of life.

Coronary Artery Disease↗
PubMed2001

Reducing emotional distress improves prognosis in coronary heart disease: 9-year mortality in a clinical trial of rehabilitation.

BACKGROUND: The impact of treating emotional distress on prognosis in coronary heart disease (CHD) has not been documented convincingly. We tested the hypothesis that treatment-related changes in emotional distress may explain the beneficial effect of rehabilitation on prognosis. METHODS AND RESULTS: In this nonrandomized clinical trial, 150 men with CHD participated in rehabilitation (n=78) or received standard medical care (n=72). There were no differences between rehabilitation and control patients with regard to left ventricular ejection fraction (LVEF) or standard care. End points were reduction in distress after 3 months and mortality after 9 years. At the end of the 3-month trial, 64 patients (43%) reported improvement and 22 (15%) reported deterioration in negative affect. Rehabilitation patients improved more (P=0.004) and deteriorated less (P=0.001) than control patients; rehabilitation was effective in reducing distress. After 9 years of follow-up, 15 patients had died (13 cardiac and 2 cancer deaths). Mortality was associated with LVEF </=50% (P=0.038) and deterioration in negative affect (P=0.007). Rate of death was 17% (12/72) for control patients versus 4% (3/78) for rehabilitation patients (P=0.009); rehabilitation was effective in reducing mortality. LVEF </=50% (OR 3.2; 95% CI 1.1 to 9.8; P=0.041) and rehabilitation (OR 0.2; 95% CI 0.1 to 0.7; P=0.016) were independent predictors of mortality. Rehabilitation warded off the deleterious effect of deterioration in negative affect on prognosis. CONCLUSIONS: Deterioration in negative affect is associated with a high long-term mortality risk. Warding off deterioration in negative affect is a mechanism that may explain the beneficial effect of comprehensive rehabilitation on prognosis in patients with CHD.

Belgium↗
PubMed2001

Screening for solid organ malignancies prior to heart transplantation.

BACKGROUND: Prognosis of solid organ cancer in immunosuppressed hosts is generally dismal. Therefore, every effort to identify patients with asymptomatic carcinomas before transplantation should be encouraged. METHODS: Sixty-seven patients referred for heart transplantation were examined adhering to the scheme proposed at the 24th Bethesda Conference. To increase the sensitivity of this work-up, the following items were added: tumor marker assays (prostate-specific antigen in males, carcino embryogenic antigen), abdominal ultrasound, CT scan of the abdomen and the thorax, mammography/echography of the breasts, PAP smear, colonoscopy if carcino embryogenic antigen abnormal or occult blood in stool, prostate echography if prostate-specific antigen abnormal or prostate hypertrophy. RESULTS: Carcinoma was detected in 10 of the 67 patients; for 8 patients of this cancer group, transplantation was denied. Importantly, 9 of the 10 malignancies were detected by means of the diagnostic items that were added to the standard screening protocol. There were no significant differences between the cancer and the non-cancer group regarding mean age, sex, etiology of heart failure, and smoking history. Stratifying patients in younger (i.e., < or =54 years) and older (i.e., > or =55 years) age groups showed a significantly greater proportion of older patients in the cancer group (8/10=80%) compared to the non-cancer group (25/57=44%), P=0.04. After a mean follow-up of 34 months, 5 of the 36 transplanted patients developed a malignancy (4 skin carcinomas, 1 non-Hodgkin lymphoma). There have been no malignancy-related deaths until now. CONCLUSION: The importance of a thorough screening program in the triage of candidates with preexisting malignancies, especially in an older patient population, is illustrated in this report.

Adult↗
PubMed2000

Inadequate response to treatment in coronary heart disease : adverse effects of type D personality and younger age on 5-year prognosis and quality of life.

BACKGROUND: Improvement in treatment of patients with coronary heart disease (CHD) has caused longer survival but also an increase in the number of patients at risk for subsequent cardiac events and impaired quality of life (QOL). We hypothesized that chronic emotional distress confers an increased risk of poor outcome despite appropriate treatment. METHODS AND RESULTS: This prospective study examined the 5-year prognosis of 319 patients with CHD. Baseline assessment included symptoms of depression/anxiety and distressed personality type (type D-ie, high negative affectivity and social inhibition). The main end points were cardiac death or nonfatal myocardial infarction and impaired QOL. There were 22 cardiac events (16 nonfatal); they were related to left ventricular ejection fraction (LVEF) </=50%, poor exercise tolerance, age </=55 years, symptoms of depression, and type D personality. Multivariate analysis yielded LVEF </=50% (OR, 3.9; P=0.009), type D personality (OR, 8.9; P=0.0001), and age </=55 years (OR, 2.6; P=0.05) as independent predictors of cardiac events. Convergence of these risk factors predicted the absence of the expected therapeutic response that was observed in 10% of the patients. When 2 or 3 risk factors occurred together, the rate of poor outcome was 4-fold higher (P=0. 0001). Estimates of medical costs increased progressively with an increasing number of risk factors. Smoking, symptoms of depression, and type D personality were independent predictors of impaired QOL. CONCLUSIONS: Decreased LVEF, type D personality, and younger age increase the risk of cardiac events; convergence of these factors predicts nonresponse to treatment. Emotionally stressed and younger patients with CHD represent high-risk groups deserving of special study.

Adult↗
PubMed2000

Type D personality. A potential risk factor refined.

OBJECTIVE: Acute and chronic psychological distress have been associated with coronary heart disease (CHD) but little is known about the determinants of distress as a coronary risk factor. Broad and stable personality traits may have much explanatory power; this article selectively focuses on negative affectivity (NA; tendency to experience negative emotions) and social inhibition (SI; tendency to inhibit self-expression in social interaction) in the context of CHD. METHODS: The first part of this article reviews research on NA and SI in patients with CHD. The second part presents new findings on NA and SI in 734 patients with hypertension. RESULTS: Accumulating evidence suggests that the combination of high NA and high SI designates a personality subtype ("distressed" type or type D) of coronary patients who are at risk for clustering of psychosocial risk factors and incidence of long-term cardiac events. Type D and its contributing low-order traits (dysphoria/tension and reticence/withdrawal) could also be reliably assessed in a community-based sample of patients with hypertension. This finding was replicated in men and women, and in Dutch- and French-speaking subjects. Type D hypertensives reported more depressive affect than their non type D counterparts. CONCLUSIONS: There is an urgent need to adopt a personality approach in the identification of patients at risk for cardiac events. NA and SI are broad and stable personality traits that may be of special interest not only in CHD, but in other chronic medical conditions as well.

Adaptation, Psychological↗
PubMed1998

Personality, disease severity, and the risk of long-term cardiac events in patients with a decreased ejection fraction after myocardial infarction.

BACKGROUND: Patients with myocardial infarction (MI) with a decreased left ventricular ejection fraction (LVEF) have a poor prognosis, but the role of emotional stress in prognosis is not known. We hypothesized that emotional stress in these patients (1) is unrelated to the severity of cardiac disorder, (2) predicts cardiac events, and (3) is a function of basic personality traits. METHODS AND RESULTS: Eighty-seven patients with MI (age, 41 to 69 years) with an LVEF of < or =50% underwent psychological assessment at baseline. Patients and their families were contacted after 6 to 10 years (mean, 7.9 years); cardiac events were defined as cardiac death or nonfatal MI. Emotional distress was unrelated to the severity of cardiac disorder. At follow-up, 21 patients had experienced a cardiac event (13 fatal events). These events were related to LVEF of < or =30%, poor exercise tolerance, previous MI, anxiety, anger, and depression (all P< or =.02). Patients with a distressed personality (type D; ie, the tendency to suppress negative emotions) were more likely to experience an event over time compared with non-type D patients (P=.00005). Cox proportional hazards analysis yielded LVEF of < or =30% (relative risk, 3.0; 95% confidence interval, 1.2 to 7.7; P=.02) and type D (relative risk, 4.7; 95% confidence interval, 1.9 to 11.8; P=.001) as independent predictors. Anxiety, anger, and depression did not add to the predictive power of type D; these negative emotions were highly correlated and reflected the personality domain of negative affectivity. CONCLUSIONS: Personality influences the clinical course of patients with a decreased LVEF. Emotional distress in these patients is unrelated to disease severity but reflects individual differences in personality. Clinical trials should take a broad view of the target of intervention; assessment of LVEF and personality may identify patients at risk.

Adult↗
PubMed1998

Personality and coronary heart disease: the type-D scale-16 (DS16).

Clinical diagnoses of depression, self-reported negative emotions, and personality traits have been associated with both the development and progression of coronary heart disease (CHD). This article focusses on negative affectivity (the tendency to experience negative emotions) and social inhibition (the tendency to inhibit self-expression in social interaction) in CHD patients. Two independent samples of patients with CHD were included in this study. Both empirical and internal-structural criteria were used to devise a brief self-report measure comprising an eight-item negative affectivity and an eight-item social inhibition scale in Sample 1 (N = 400). These scales were internally consistent (alpha = .89 and .82), stable over time (three-month test-retest reliability = .78 and .87) and were validated against standard personality scales. CHD patients with a "distressed" personality (Type-D) report high levels of negative affectivity and social inhibition; accordingly, this self-report measure was termed Type-D Scale-16 (DS16). Previous research showed that Type-D was associated with cardiac events and incidence of cancer in patients with CHD. Type-D as measured by the DS16 was associated with depressive affect and symptoms, stress, poor self-esteem, dissatisfaction with life, and low positive affect in Sample 2 (N = 100) of the present article. It is concluded that research on CHD should focus on affective disorder, specific negative emotions, and global personality traits, and that the DS16 is a practical, sound research tool that can be used to assess Type-D.

Adult↗
PubMed1998

Personality and risk of cancer in men with coronary heart disease.

BACKGROUND: There still is much debate with regard to the role of psychosocial factors in cancer. Evidence suggests that cancer and coronary heart disease (CHD) may have common causes. This study examined the role of pessimism, anxiety and personality in the development of cancer among men who had been diagnosed with CHD but were free of cancer at baseline. METHODS: Two hundred and forty-six men who were treated for CHD, but were free of cancer, filled out psychological scales at baseline. Patients and their families were contacted after 6-10 years to determine the incidence of cancer. RESULTS: At follow-up, 12 patients (5%) had been diagnosed with cancer (9 cancer deaths). Development of cancer was unrelated to cardiac pathology but was associated with age > or = 56 years, poor exercise tolerance, pessimism and anxiety. The rate of cancer was 8/60 = 13% for men with a distressed personality (type-D) and 4/186 = 2% for non-type-D men (P = 0.002); rate of cancer death was 10% and 2%, respectively (P = 0.007). Type-D refers to the interaction between high negative affectivity and high social inhibition. Regression analysis yielded older age (odds ratio 4.6, 95% CI 1.5-14.3) and type-D (odds ratio 7.2, 95% CI 2.9-18.1) as independent prognostic factors for cancer. CONCLUSIONS: Type-D personality was a prognostic factor for the development of cancer in men with established CHD. Psychosomatic research should take a broad enough view of the specific and the global psychosocial variables that may play a role in both cancer and CHD.

Adult↗
PubMed1996

Personality as independent predictor of long-term mortality in patients with coronary heart disease.

BACKGROUND: Emotional distress has been related to mortality in patients with coronary heart disease (CHD), but little is known about the role of personality in long-term prognosis. We postulated that type-D personality (the tendency to suppress emotional distress) was a predictor of long-term mortality in CHD, independently of established biomedical risk factors. METHODS: We studied 268 men and 35 women with angiographically documented CHD, aged 31-79 years, who were taking part in an outpatient rehabilitation programme. All patients completed personality questionnaire at entry to the programme. We contacted them 6-10 years later (mean 7-9) to find out survival status. The main endpoint was death from all causes. FINDINGS: At follow-up, 38 patients had died; there were 24 cardiac deaths. The rate of death was higher for type-D patients than for those without type-D (23 [27%]/85 vs 15 [7%]/218; p < 0.00001). The association between type-D personality and mortality was still evident more than 5 years after the coronary event and was found in both men and women. Mortality was also associated with impaired left ventricular function, three-vessel disease, low exercise tolerance, and the lack of thrombolytic therapy after myocardial infarction. When we controlled for these biomedical predictors in multiple logistic regression analysis, the impact of type-D remained significant (odds ratio 4.1 [95% CI 1.9-8.8]; p = 0.0004). In this group of CHD patients, type-D was an independent predictor of both cardiac and non-cardiac mortality. Social alienation and depression were also related to mortality, but did not add to the predictive power of type-D. INTERPRETATION: We found that type-D personality was a significant predictor of long-term mortality in patients with established CHD, independently of biomedical risk factors. Personality traits should be taken into account in the association between emotional distress and mortality in CHD.

Adult↗
PubMed1995

Enhancing emotional well-being by comprehensive rehabilitation in patients with coronary heart disease.

Since emotional distress is linked to poor prognosis in coronary patients, there is urgent need for research into interventions that may enhance emotional well-being in these patients. Cardiac rehabilitation aims to return the individual to optimal emotional function, but the psychological effect of this therapy still needs to be demonstrated. Hence, we examined the role of cardiac rehabilitation in enhancing emotional health. We examined 170 male patients with coronary heart disease, of whom 85 had participated in the outpatient rehabilitation programme of the University Hospital of Antwerp and 85 had received standard medical care only in two other hospitals. Rehabilitation and control patients were matched by medical category and tendency to experience distress. The Global Mood Scale, the Health Complaints Scale, and the Heart Patients Psychological Questionnaire were used to assess changes in emotional well-being over a 3-month period. These changes were significantly different as a function of cardiac rehabilitation (P<0.0001). Rehabilitation patients, but not control patients, reported a significant improvement in negative affect, positive affect, well-being , health and disability (P<0.001). At follow-up, differences in depression, tranquillizer use (P<0.05), and activity profile (P<0.01) confirmed that rehabilitation patients displayed more healthy behaviour than control patients. Patients not only improved more, but also deteriorated less as a function of rehabilitation. This therapy also had a positive effect on patients suffering minimal distress, which is at variance with previous research. These findings suggest that comprehensive rehabilitation may be an effective therapy for enhancing emotional well-being in patients with coronary heart disease.

Analysis of Variance↗
PubMed1993

Biobehavioral research on coronary heart disease: where is the person?

This study examined the thesis that patients with coronary heart disease (CHD) comprise discrete personality subtypes and that identification of these subtypes may benefit biobehavioral research on CHD. Measures of Negative Affectivity, Social Inhibition, and Self-Deception were used to generate a personality taxonomy through cluster analysis in a sample of 405 men with CHD. This empirical taxonomy served as a basis for the development of a conceptual model which delineates hardy, distressed, inhibited, and repressive subtypes. Coronary proneness may differ across these subtypes to the extent that potential behavioral correlates of CHD were associated with subtype membership. Distressed individuals (characterized by elevated levels of Type A behavior, anger, hostility, and life stress) and inhibited individuals (characterized by the nonexpression of anger) may be particularly coronary prone. It is concluded that research should focus on the interaction of global traits that may define subtypes of patients with CHD.

Adaptation, Psychological↗
PubMed1993

Emotional distress and fatigue in coronary heart disease: the Global Mood Scale (GMS).

Evidence indicates that emotional distress has a long-term impact on morbidity and mortality in patients with coronary heart disease (CHD), and that symptoms of depression, fatigue, and reduced energy may identify high-risk patients. This study was designed to: (1) devise a sound and practical measure of emotional distress in CHD patients; (2) examine the relationship between emotional distress and fatigue following CHD; and (3) examine changes in emotional distress as a function of cardiac rehabilitation. A sample of 478 men with CHD (mean age = 57.8 +/- 8.7 y) filled out questionnaires 3-6 weeks following a myocardial infarction (N = 110), bypass surgery (N = 302), or coronary angioplasty (N = 66). Statistical analyses of 56 Dutch mood terms were used to produce the 20-item Global Mood Scale (GMS) which measures negative affect (characterized by fatigue and malaise), as well as positive affect (characterized by energy and sociability), in patients with CHD. The GMS was found to be a reliable scale (alpha > 0.90; r > 0.55 over a 3-month period), and correlations with existing measures of emotional functioning and self-deception indicated its convergent and discriminant validity. Most importantly, fatigue was not related to cardiorespiratory fitness in a subset of 140 patients, but clearly was associated with negative affect. Consistent with the self-efficacy model, scores on the GMS mood scales improved significantly as a function of rehabilitation (P < 0.0001). Although symptoms of emotional distress are easily explained away by situational factors, previous research suggests that failure to recognize the clinical significance of these symptoms in CHD patients may result in the delay of much needed intervention. The current findings suggest that the GMS is a theoretically and psychometrically sound measure of emotional distress in CHD patients, and that this scale is sufficiently sensitive to assess change.

Aged↗
PubMed1993

Sensitivity of outcome assessment in cardiac rehabilitation.

I hypothesized that measures that match the theoretically prescribed effect of cardiac rehabilitation (i.e., enhancement of subjective health and well-being) are more appropriate to assess change than are measures of psychopathology. Study 1 examined the differential sensitivity to change of 3 measures in a sample of 162 men with coronary heart disease (CHD) who participated in cardiac rehabilitation. Ss reported less change on the State-Trait Anxiety Inventory and the Symptom Check List than on the Heart Patients Psychological Questionnaire, but in the absence of a control group it is difficult to known what caused this change. In Study 2, 60 men with CHD who participated in rehabilitation were compared with 60 men with CHD who received standard medical care alone. Rehabilitation Ss, but not control Ss, reported a decrease in disability and an increase in well-being as measured by the HPPQ. I concluded that sensitive measures may actually provide evidence for the psychological effect of cardiac rehabilitation.

Adult↗
PubMed1992

Coping subtypes for men with coronary heart disease: relationship to well-being, stress and Type-A behaviour.

We used cluster analysis to delineate coping subtypes in a sample of 166 men with coronary heart disease who completed the Antwerp out-patient rehabilitation programme. These subtypes were identified on the basis of three well-defined superordinate traits that were selected from a comprehensive taxonomy: negative affectivity, social inhibition, and self-deception. Using Ward's minimum variance method and the cubic clustering criterion, we identified four coping subtypes; low-negative affectivity (N = 48), high-negative affectivity (N = 30), inhibited (N = 62), and repressive (N = 26) individuals. The accuracy of the resulting classification was demonstrated across parallel data sets and was further validated against external, health-related correlates that were not included in the clustering. The identified coping subtypes were significantly related to self-reports of subjective distress/perceived stress, ratings of Type A behaviour and anger-in, return to work, prevalence of chest-pain complaints, and use of minor tranquillizers and sleeping pills. The major findings of this study suggest that (a) male coronary patients represent a heterogeneous population with distinctly different coping subtypes, and that (b) a relatively small number of homogeneous subtypes can account for a substantial amount of variance in subjective well-being, coronary-prone behaviour, and return to work. These findings indicate that psychosomatic research should focus on how superordinate traits interact within individuals and corroborate the appropriateness of a class model to describe coping styles of male coronary patients. It is argued that discrepant findings across studies of Type-A behaviour and hostility may be related to the coping subtypes of the subject sample. Further attempts to cross-validate this classification scheme and to examine its health-related correlates are needed.

Adaptation, Psychological↗