Reducing Emotional Distress Improves Prognosis in Coronary Heart Disease: 9-Year Mortality in a Clinical Trial of Rehabilitation
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Background The impact of treating emotional distress on prognosis in coronary heart disease (CHD) has not been documented convincingly. We tested the hypothesis that treatment-related changes in emotional distress may explain the beneficial effect of rehabilitation on prognosis. Methods and Results In this nonrandomized clinical trial, 150 men with CHD participated in rehabilitation (n=78) or received standard medical care (n=72). There were no differences between rehabilitation and control patients with regard to left ventricular ejection fraction (LVEF) or standard care. End points were reduction in distress after 3 months and mortality after 9 years. At the end of the 3-month trial, 64 patients (43%) reported improvement and 22 (15%) reported deterioration in negative affect. Rehabilitation patients improved more ( P =0.004) and deteriorated less ( P =0.001) than control patients; rehabilitation was effective in reducing distress. After 9 years of follow-up, 15 patients had died (13 cardiac and 2 cancer deaths). Mortality was associated with LVEF ≤50% ( P =0.038) and deterioration in negative affect ( P =0.007). Rate of death was 17% (12/72) for control patients versus 4% (3/78) for rehabilitation patients ( P =0.009); rehabilitation was effective in reducing mortality. LVEF ≤50% (OR 3.2; 95% CI 1.1 to 9.8; P =0.041) and rehabilitation (OR 0.2; 95% CI 0.1 to 0.7; P =0.016) were independent predictors of mortality. Rehabilitation warded off the deleterious effect of deterioration in negative affect on prognosis. Conclusions Deterioration in negative affect is associated with a high long-term mortality risk. Warding off deterioration in negative affect is a mechanism that may explain the beneficial effect of comprehensive rehabilitation on prognosis in patients with CHD.
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Treatment-induced decreases in Neuroticism reduced risk of mortality over 9 years in European patients with CVD.
“Treatment-induced decreases in Neuroticism also reduced risk of mortality over 9 years in European patients with cardiovascular disease (CVD) [116].”
From Personality and Longevity: Knowns, Unknowns, and Implications for Public Health and Personalized Medicine (2011) · cites this paper as [116]
Psychosocial interventions have successfully reduced Type D traits.
“psychosocial interventions have successfully reduced hostility [248], Type D traits [116], and deficits in social and emotional functioning in CVD patients [249]”
From Personality and Longevity: Knowns, Unknowns, and Implications for Public Health and Personalized Medicine (2011) · cites this paper as [116]
In the Type D traits study, patients showed improved 9-year survival rates.
“in the latter two studies, patients showed improved 9-year survival rates [116] and reductions in sclerosis in the fundus of the eye [249].”
From Personality and Longevity: Knowns, Unknowns, and Implications for Public Health and Personalized Medicine (2011) · cites this paper as [116]
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- Authors
- Denollet, J., & Brutsaert, D. L.
- Affiliations
- Tilburg University (NL)
- ORCID
- Denollet, Johan
- Venue
- Circulation
- Published
- 2001-10-23
- Volume
- 104
- Issue
- 17
- Pages
- 2018-2023
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2162925874
- Cited by
- 121
- References
- 37
- Citations by year
- 2025: 1 · 2024: 1 · 2021: 4 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 5 · 2015: 4 · 2014: 2 · 2013: 7 · 2012: 7
- FWCI
- 5.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- Research portal (Tilburg University) (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- coronary artery disease, emotional distress, negative affect, cardiac rehabilitation, prognosis, mortality, left ventricular ejection fraction, long-term follow-up
- MeSH terms
- Coronary Artery Bypass, Belgium, Coronary Disease, Exercise Therapy, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Psychological Tests, Severity of Illness Index, Stress, Psychological, Stroke Volume, Time, Survival Rate, Odds Ratio, Ventricular Function, Left, Treatment Outcome, Risk Assessment
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