May 9, 2012 -- Doctors need to focus on their heart patients' psychological well-being in addition to their physical well-being, suggests a new study in the journal Circulation.
According to the research, patients with what's known as a "type D" personality -- meaning a distressed and generally pessimistic outlook on life -- may be more likely to face poor health after having an implantable cardioverter defibrillator (ICD) put in place than other patients with the same device.
An ICD monitors the heart and shocks it back on course if its rhythm becomes life-threatening.
"In my opinion, screening patients would be a worthwhile endeavor, as it will provide important information to health care professionals managing and caring for ICD patients on the patient's psychological vulnerability," researcher Susanne Pedersen, PhD, tells WebMD in an email.
Pedersen, a psychologist at Tilburg University in the Netherlands, and her colleagues followed 383 patients -- nearly 80% of them men -- for a year. Each participant completed a health questionnaire to assess their health before being fitted with an ICD. The participants were also evaluated psychologically to determine whether they had a type D personality.
Type Ds Are High-Risk Patients
Type Ds have a lot of negative emotions and tend to keep the emotions to themselves. Nearly a quarter of the patients enrolled in the study had a type D personality.
At three-month intervals, the participants re-evaluated their health using the same questionnaire they were given at the beginning of the study.
By the end of the study period, the researchers were able to show that those with a type D personality had significantly lower health scores than those without the distressed personality. Type D defibrillator patients reported greater difficulty performing everyday tasks, functioning at work, and interacting with others. They also suffered more from severe and debilitating pain.
The researchers also studied the reports of patients whose ICDs had delivered a shock to them during the year-long period. Overall, about 14% of all patients enrolled in the study experienced a shock. While the health rating scores of such patients were as much as 13 points lower than other patients, Pedersen and her team found that type D patients who received a shock scored as many as 30 points lower.
Patient Counseling and Psychological Intervention Likely to Help
Pedersen says it's important for doctors to emphasize to their patients that the majority of people who need an ICD do well with the device. But it is also essential that patients, particularly those with type D personalities, understand that their outlook on life will influence how they fare.
"Heart disease and receiving an ICD are major life events, but it is possible to lead a normal life with an ICD, and the art is to engage in activities that are important to patients and from which they derive joy and happiness," says Pedersen. "This may be easier said than done, but being aware of it and working on it, if necessary with the help of health care professionals, can provide patients with a full life, with a good quality of life."
Cardiologist Byron Lee, MD, a defibrillator specialist at the University of California San Francisco Medical Center, agrees with Pedersen that doctors, including himself, need to take into account their ICD patients' psychological well-being.
"We're so focused on the body and its diseases that we don't pay enough attention to their state of mind before or after their procedure," say Lee, who was not involved in the research. "This study underscores the need to pick up on this, and it shows that that can be done with very simple questionnaires."
Lee says that such screening could lead to psychological interventions aimed at relieving a patient's emotional distress before that distress causes real harm.