Elsevier

International Journal of Cardiology

Volume 219, 15 September 2016, Pages 380-386
International Journal of Cardiology

Differences of psychological features in patients with heart failure with regard to gender and aetiology — Results of a CAPS-LOCK-HF (Complex Assessment of Psychological Status Located in Heart Failure) study

https://doi.org/10.1016/j.ijcard.2016.06.036Get rights and content

Abstract

Objective

Objective of the study was to assess the psychological state of HF patients with reduced ejection fraction (HFrEF) with regard to gender and aetiology.

Methods

758 patients with HFrEF (mean age — 64 ± 11 years, men — 79%, NYHA class III–IV — 40%, ischemic aetiology — 61%) in a prospective Polish multicenter Caps-Lock-HF study. Scores on five different self-report inventories: CISS, MHLC, GSES, BDI and modified Mini-MAC were compared between the sexes taking into account the aetiology of HFrEF.

Results

There were differences in the CISS and BDI score between the genders – women had higher CISS (emotion- and avoidance-oriented) and BDI (general score — 14.2 ± 8.7 vs 12.3 ± 8.6, P < 0.05; subscale — somatic score — 7.3 ± 3.7 vs 6.1 ± 3.7, P < 0.05). In the ischemic subpopulation, women had higher BDI (general and subscales) than men. In the non-ischemic subpopulation the differences between genders were limited to CISS scale. In a multivariable analysis with demographic and clinical data female sex, NYHA class, atrial fibrillation and diabetes mellitus determined BDI score. Similarly, in the ischemic subpopulation, the female sex, NYHA class and atrial fibrillation determined the BDI, while in the non-ischemic population NYHA class was the only factor that influenced the BDI score. Adding the psychological data made a significant additional contribution to the prediction of depression status.

Conclusions

There are distinct differences in psychological features with regard to gender in patients with HFrEF. Women demonstrate less favourable psychological characteristics. Gender-related differences in BDI score are especially explicit in patients with ischemic aetiology of HF. The BDI score is related to psychological predisposition.

Introduction

Heart failure (HF) is a chronic, long-lasting disease, the progression of which can be somewhat postponed, but not stopped [1]. Nowadays, HF constitutes one of the most frequent diseases in well-developed countries [2] and is the most common cause of hospitalisation in patients over 65 years of age [3].

Prior investigators of HF found that clinical characteristics and general outcomes differ between genders [4], [5]. According to some authors the quality of life in patients with HF depends on gender [6]. The configuration of psychological features might play an important role in the context of the general outcome in patients with HF. Psychological features have been established to assist in choosing the approach for treating individuals with chronic diseases, i.e. HF. Moreover, the influence of psychological characteristic of patient might be of relevant contribution to depression development. In the literature, only a few studies have focused on the psychological gender-related features in this population [7].

Some suggestions were proposed that psychological interventions could enhance compliance among HF patients, e.g., due to the improved cooperation between physicians and patients [8]. In this context, psychological characteristics may be of crucial importance for good compliance.

Summarising, it is very likely that the psychological reaction toward HF differs between the sexes. The identification of psychological characteristics for men and women seems to be a useful strategy for the development of gender-based risk profiles and the determination of targets for gender-based interventions. It is reasonable to assess psychological reactions separately in ischemic and non-ischemic aetiology of HF thus the aetiology determinates further treatment and prognosis.

The aim of the present study was to compare differences in the psychological features in patients with heart failure with regard to gender and the aetiology of HF.

Section snippets

Methods

A total of 758 patients with chronic HFrEF (599 men and 159 women) were prospectively enrolled into the CAPS-LOCK-HF (Complex Assessment of Psychological Status LOCKated in Heart Failure) study. The CAPS-LOCK-HF study was conducted in Poland between September 2012 and March 2013 at eleven cardiology centres. The study was aimed to assess psychological status of patients with chronic compensated HFrEF that were hospitalised or visiting outpatient clinic [9].

The general study population

General population – patients' characteristics with regard to sex

We found distinctive differences between men and women (Table 1a, Table 1b). The men were younger than the women (63.2 ± 10.7 vs 65.8 ± 12 years, P < 0.05) and had a lower left ventricular ejection fraction (30.6 ± 8.8 vs 34.4 ± 8.2%, P < 0.05). The NYHA class and median duration of the HF symptoms did not differ between the genders.

The men had a higher prevalence of coronary artery disease, MI, prior coronary artery bypass surgery or coronary angioplasty but did not differ in their history of hypertension,

Discussion

The differences between men and women in HF have been widely described. Men and women suffer from HF differently, and the problems that result from HF affect different areas [19], [20]. In this field, many papers have been published with regard to the aetiology of HF, a history of MI, a previous coronary revascularisation and other contributing factors [21], [22]. However, the psychological features in females and males with HF and a psychological predisposition for the illness remain unclear.

Conflict of interest

None declared.

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