People with a distressed (Type D) personality reported worse health than other patients after having devices implanted to ensure proper heart rhythm, according to new research in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

Those reporting worse health within a year of having the internal defibrillators implanted were assessed before the procedure and found to have “Type D” personality traits, meaning they tend toward increased negative emotions but don’t share them with others due to fear of rejection.

In a study of 383 patients in the Netherlands, researchers also found that all implantable cardioverter defibrillator (ICD) patients whose devices shocked their hearts back into normal rhythm within a year of the procedure reported poorer health status. ICDs monitor heart rhythms and deliver Electrical shocks to restore normal rhythm when life-threatening irregular heartbeats occur.

Patients who had both a Type D personality and whose defibrillators delivered a shock within the first year reported the worst health of all.

“The finding is important because it demonstrates that the trauma of experiencing the lifesaving shock isn’t the only factor contributing to a patient’s sense of his or her well-being and identifies a group of patients who may need additional care to improve survivability,” said Susanne S. Pedersen Ph.D., lead author of the study and professor of cardiac psychology at Tilburg University and at the Thoraxcenter at Erasmus Medical Center in Rotterdam, the Netherlands. “If we only focus on patients who have received a shock, we risk under-diagnosing patients with distress and not providing them with the additional treatment they may need.”

Participants in the study (79 percent men) answered questions to assess their health status and determine if they had a Type D personality.

The personality questionnaire required a response to statements such as “I often feel unhappy” or “I am a closed kind of person.” Patients rated their health on a scale from 0 to 100 the day before their defibrillator was implanted and again at three, six and 12 months later. About 24 percent of the group had a Type D personality while 14 percent had experienced a shock within the first year.

Other findings about how patients rated their health:

  Patients who received a shock during the first year rated their physical and mental health 3 to 13 points lower than those who didn’t.
  Patients with Type D traits scored themselves 2 to 8 points lower than others.
  Patients who had both Type D personality traits and had received a shock scored themselves up to 30 points lower than others.

Researchers did not have information about any changes in medications during the 12-month study period that may have influenced patients’ health.

Pedersen said similar results would be expected among American patients but said the study should be repeated as defibrillators may be programmed more conservatively in the United States leading to differences in the number of shocks that patients may experience in Europe and in the United States.

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Co-authors are Fetene B. Tekle, Ph.D.; Madelein T. Hoogwegt, M.Sc.; Luc Jordaens, M.D., Ph.D.; and Dominic A.M.J. Theuns, Ph.D. Author disclosures are in the manuscript.

The Netherlands Organization for Scientific Research and the Netherlands Organization for Health Research and Development provided funding.

Learn more about implantable cardioverter debrillators.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content.

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Carrie Thacker
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American Heart Association