Poor health-related quality of life in patients with peripheral arterial disease: Type D personality and severity of peripheral arterial disease as independent predictors

Abstract

Peripheral arterial disease (PAD) is associated with poor health-related quality of life (HRQOL), but individual differences in this patient-based outcome are not fully understood. We examined the impact of PAD severity, invasive treatment, and type D personality, defined as tendencies to experience negative emotions and be socially inhibited, on HRQOL in a 1-year follow-up study. At their first visit to the department of surgery at the St. Elisabeth Hospital in Tilburg, The Netherlands, 203 consecutive PAD patients completed the DS14 type D personality and RAND-36 questionnaires (all self-report). Clinical data were derived from patients' medical files and included ankle-brachial index (ABI), initial and absolute claudication distance (ICD, ACD), and invasive treatment. The main outcome was HRQOL at 1-year follow-up. HRQOL improved between baseline and follow-up, and invasive treatment led to significant improvements in the subscales Physical Functioning (P = .005) and Pain (P = .003). Type D patients were severely impaired in their HRQOL compared with other patients at baseline (P < .01) and at follow-up (P < .05). ABI and ACD also predicted HRQOL at follow-up. After adjusting for ABI and ACD, invasive treatment and type D personality independently predicted all HRQOL domains, except for Physical Functioning. Overall, type D personality predicted increased risk for both poor General Health (odds ratio [OR], 3.70; 95% confidence interval [CI], 1.69 to 8.08; P = .001) and poor Mental Health (OR, 6.01; 95% CI, 2.44 to 14.79, P < .0001) at 1 year after the PAD diagnosis. Despite an overall improvement, type D patients remained more impaired in 1-year HRQOL than other patients, adjusting for ABI and ACD. Type D personality is a psychologic risk factor that predicts poor patient-based outcomes in PAD and should be taken into account when HRQOL in PAD is evaluated.