Welbevinden bij hartpatiënten : samenstelling van een medisch psychologische vragenlijst (de MPVH) ter bepaling van het welzijn bij hartpatiënten

Dit proefschrift geeft een beschrijving van de totstandkoming, val idering en normering van een psychologische vragenlijst specifiek van toepassing op hartpatienten. Aanleiding voor het onderzoek was het ontbreken van een dergelijk meet instrument binnen Nederland. Doelstell ing van het onderzoek is uiteindelijk om het psychisch welzijn of welbevinden van hartpatienten getalsmatig uit te drukken, door middel van een vragenl ijst. De vragenlijst is zo vervaardigd dat ze op zichzelf een gemakkelijk toepasbaar diagnosticum werd. Als orienterende inleiding wordt in hoofdstuk aandacht besteed aan de verschillende raakvlakken die er bestaan tussen de psychologie en de cardiologie. Daarbij is een deling gemaakt tussen prospectief en retrospectief onderzoek. Aan de hand van dit literatuuronderzoek is, voor wat betreft het prospectieve deel, gezocht naar psychologische fenomenen die een bijdrage zouden kunnen leveren aan het voorspellen van coronair lijden. Naast een aantal somatische risicofactoren en psychosociale prodromata worden in dit verband het type-A gedrag (beschreven door de groep van Friedman en Rosenman) en een chronisch depressieve stemming het meest frequent genoemd. In beide gevallen is er sprake van introjectie van vijandige en agressieve gevoelens en gedachten. De prospectieve betrouwbaarheid van deze twee syndromen wordt echter nogal eens in twijfel getr

Home measures of anxiety, avoidant coping and defence as predictors of anxiety, heart rate and skin conductance level just before invasive cardiovascular procedures

The question was whether anxiety, heart rate and skin conductance level just before invasive cardiac procedures could be predicted by anxiety related measures obtained at patients homes approximately 3 weeks before treatment. Trait measures of avoidant coping and defence were provided by sixty-three male and thirty-three female patients who were scheduled for a diagnostic or interventional heart catheterization. In hospital physiological measures were registered continously during a 20 min interview and subsequently patients reported their anxiety. Results with hierarchical regres

Anhedonia is associated with poor health status and more somatic and cognitive symptoms in patients with coronary artery disease

Purpose: The effectiveness of cardiac rehabilitation (CR) in patients with coronary artery disease (CAD) is moderated by negative emotions and clinical factors, but no studies evaluated the role of positive emotions. This study examined whether anhedonia (i.e. the lack of positive affect) moderated the effectiveness of CR on health status and somatic and cognitive symptoms. Methods: CAD patients (n = 368) filled out the Hospital Anxiety and Depression Scale (HADS) to assess anhedonia at the start of CR, and the Short-Form Health Survey (SF-36) and the Health Complaints Scale (HCS) at the start of CR and at 3 months to assess health status and somatic and cognitive symptoms, respectively. Results: Adjusting for clinical and demographic factors, health status improved significantly during the follow-up (F(1,357) = 10.84, P = .001). Anhedonic patients reported poorer health status compared with non-anhedoni

Co-occurrence of diabetes and hopelessness predicts adverse prognosis following percutaneous coronary intervention

We examined the impact of co-occurring diabetes and hopelessness on 3-year prognosis in percutaneous coronary intervention patients. Consecutive patients (n = 534) treated with the paclitaxel-eluting stent completed a set of questionnaires at baseline and were followed up for 3-year adverse clinical events. The incidence of 3-year death/non-fatal myocardial infarction was 3.5% in patients with no risk factors (neither hopelessness nor diabetes), 8.2% in patients with diabetes, 11.2% in patients with high hopelessness, and 15.9% in patients with both factors (p = 0.001). Patients with hopelessness (HR: 3.28; 95% CI: 1.49-7.23) and co-occurring diabetes and hopelessness (HR: 4.89; 95% CI: 1.86-12.85) were at increased risk of 3-year adverse clinical events compared to patients with no risk factors, whereas patients with diabetes were at a clinically relevant but not statistically significant risk (HR: 2.40; 95% CI: 0.82-7.01). These results remained, adjusting for baseline characteristics an

Type D patients report poorer health status prior to and after cardiac rehabilitation compared to non-type D patients

Background: Type D personality is an emerging risk factor in coronary artery disease (CAD). Cardiac rehabilitation (CR) improves outcomes, but little is known about the effects of CR on Type D patients. Purpose: We examined (1) variability in Type D caseness following CR, (2) Type D as a determinant of health status, and (3) the clinical relevance of Type D as a determinant of health status compared to cardiac history. Methods: CAD patients (n = 368) participating in CR completed the Type D Scale, the Short-Form Health Survey 36 pre- and post-CR, and the Hospital Anxiety and Depression Scale pre-CR, to assess health status and depressive and anxious symptomatology, respectively. Results: The prevalence of Type D decreased from 26.6% to 20.7% (p = 0.012) following CR, but Type D caseness remained stable in 81% of patients. Health status significantly improved following CR [F(1,359) = 17.48, p < 0.001], adjusting for demographic and clinical factors and anxious and depressive symptoms. Type D patients reported poorer health status [F(1,359) = 10.40, p = 0.001], with the effect of Type D being stable over time [F(1,359) = 0.49, p = 0.48]. Patients with a cardiac history benefited less from CR [F(1,359) = 5.76, p = 0.02]. The influence of Type D on health status was larger compared to that for cardiac history, as indicated by Cohen's effect size index. Conclusions: Type D patients reported poorer health status compared to non-Type D patients pre- and post-CR. In the majority of patients, CR did not change Type D caseness, with Type D being associated with a stable and clinically relevant effect on outcome. These high-risk patients should