Health-related quality of life in outpatients with coronary heart disease: impact of type D personality, depression, anxiety and insomnia

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Drammen hospital, Vestre Viken trust. Background Health-related quality of life (HRQoL) is an important treatment target in patients with coronary heart disease (CHD) and associated with impaired prognosis. Therefore, knowledge about correlates of HRQoL may be of clinical importance. However, there is limited knowledge about how a comprehensive set of psychosocial factors, including type D personality, depression, anxiety, and insomnia influence HRQoL in CHD outpatients. Purpose To determine the relative associations of clinical and psychosocial factors with mental and physical HRQoL in a sample of Norwegian CHD outpatients. Methods This cross-sectional study included 1017 patients 2-36 (mean 16) months after hospitalisation for a coronary heart disease event (80% myocardial infarction). Data on HRQoL, psychosocial factors, coronary risk factors, comorbidity, and demographics were collected from self-report questionnaires, clinical examination with blood samples and hospital medical records. HRQoL was assessed using the Short Form 12 (SF12), which is a 12-item questionnaire comprising two subscales: Mental Component Scale (MCS) and Physical Component Scale (PCS). Type D personality, depression and anxiety, and insomnia were measured using the type D Scale 14 (DS14), Hospital Anxiety and Depression Scale (HADS), and the Bergen Insomnia Scale (BIS), respectively. Crude and multi-adjusted linear regression analyses were used to investigate the association between covariates and MCS and PCS, respectively. Results Mean age was 61 (SD 10) years, 20% were females, 18% had type D personality, 20% depression, 14% anxiety and 45% insomnia. Mean scores for SF12 subscales were 47.1 (6.0) for MCS and 38.5 (4.8) for PCS. Type D personality, symptoms of depression, and insomnia, but not anxiety, were negatively associated with MCS, but not PCS in multi-adjusted analyses. (Table). Chronic kidney disease was associated with reduced MCS, whereas chronic obstructive pulmonary disease and low physical activity were all negatively associated with PCS. Younger age was associated with poor MCS, whereas older age was associated with poor PCS. Conclusions This study found that HRQoL was low among Norwegian CHD outpatients. Type D personality, depressive symptoms, insomnia, and chronic kidney disease were the strongest correlates of the mental component of HRQoL. However, these variables were not significantly associated with the physical subscale of the SF12. Assessing and managing type D personality, depression, and insomnia among these group of CHD outpatients may improve HRQoL.