Research Article: Negative affectivity and social inhibition are associated with increased cardiac readmission in patients with heart failure: A preliminary observation study

Date Published: April 19, 2019

Publisher: Public Library of Science

Author(s): Tin-Kwang Lin, Kai-Xun You, Chiu-Tien Hsu, Yi-Da Li, Chin-Lon Lin, Chia-Ying Weng, Malcolm Koo, Pasquale Abete.

http://doi.org/10.1371/journal.pone.0215726

Abstract

Type D personality was hypothesized to influence clinical and patient-centered outcomes patients with heart failure. The aim of this study was to investigate the association between negative affectivity and social inhibition components of Type D personality and cardiac readmission in patients with heart failure.

A prospective observational study design was used. A total of 222 patients with heart failure were recruited from the department of cardiology in two regional hospitals in Taiwan. The 14-item Type D Scale-Taiwanese version was used to assess negative affectivity and social inhibition of the patients. Logistic regression analyses were conducted to determine the association of both Z-score transformed and dichotomized negative affectivity and social inhibition with 6-month and 18-month cardiac readmissions.

A total of 55 patients (24.8%) and 89 patients (40.1%) had cardiac readmissions within 6 months and 18 months, respectively. Multiple logistic regression analyses of Z-score transformed negative affectivity and social inhibition were significantly associated with (1) 6-month cardiac readmission with odds ratios of 1.62 (P = 0.003) and 1.48 (P = 0.014), respectively and (2) 18-month cardiac readmission with odds ratios of 1.45 (P = 0.013) and 1.38 (P = 0.031), respectively. Similar findings were obtained when negative affectivity and social inhibition were analyzed as dichotomized scores.

Negative affectivity and social inhibition components of the Type D personality were significantly associated with a higher risk of cardiac readmission in both 6 months and 18 months after the initial hospitalization in patients with heart failure.

Partial Text

Heart failure is chronic, progressive condition in which the heart is unable to provide adequate blood flow to meet the body’s needs for blood and oxygen. It is a pandemic affecting at least 26 million people worldwide [1]. The prevalence of heart failure was estimated to increase from 0.7% in persons aged 45–54 years to over 10% in those aged 85 years or older [2]. In the United States, an estimated 5.7 million people have heart failure, and the annual cost for treatment of heart failure has been estimated to be over 32 billion US dollars [3]. In addition, heart failure is a common cause of unplanned hospital admissions and readmissions [4]. About half of the patients with heart failure were readmitted to a hospital within 6 months of discharge [5]. Unplanned readmissions after initial hospitalization can significantly increase the costs of health care and affect the quality of life in patients with heart failure [6, 7]. Therefore, there is an ongoing need to identify factors to reduce readmissions after heart failure hospitalization [8].

The basic characteristics of the study participants at baseline are presented in Table 1. Patients with Type D personality, compared with non-Type D personality, were not significantly different in age, body mass index, and the distribution of sex, NYHA functional classification, smoking, comorbidities, and use of medications, but the mean score of Beck Depression Inventory was significantly higher in patients with Type D personality (P < 0.001). A total of 55 patients (24.8%) and 89 patients (40.1%) had cardiac readmissions within 6 months and 18 months, respectively. Predicting readmission risk at the time of initial hospitalization in patients with heart failure can possibly provide better risk stratification, which allows for appropriate allocation of resources and targeted intervention. The present prospective study found that both Z-score transformed NA and SI were significantly associated with an increased risk of 6-month and 18-month cardiac readmission. The risk ranged from 1.38 for 18-month cardiac readmission in Z-score transformed SI to 1.62 for 6-month cardiac readmission in Z-score transformed NA, adjusting for other potential confounders. Similar findings were obtained when NA and SI were analyzed as dichotomized scores, except SI was only marginally (P = 0.056) associated with 18-month cardiac readmission.   Source: http://doi.org/10.1371/journal.pone.0215726

 

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