This cross-sectional study found that patients with a sanguine personality had the highest score in both the overall mean AFEQT and AFEQT sub-scale. Furthermore, the percentage of anxiety and depression was lowest among AF patients in the sanguine personality group. Contrastingly, moderate to severe depression was observed in AF patients with choleric and depressive personalities. These findings indicate that personality traits might be a crucial factor affecting PROs in individuals with AF. Our results support the importance of considering personality as a component of patient evaluation and management in AF.
It is well known that personality traits and psychiatric factors are associated with cardiovascular disease risk. For example, type A behavior is linked to an increased risk of heart disease, independently from other known risk factors (serum cholesterol, high blood pressure and smoking).[22] A 2005 case-control study suggested that patients with type A behavior patterns may have a higher incidence of AF.[23] Type D personality was identified as a risk factor for myocardial infarction and cardiovascular mortality, especially in patients without traditional cardiovascular risk factors.[24] Subsequent studies have shown that negative emotions such as depression are associated with an elevated risk of CHD [25] and AF.[26] Our conclusion is consistent with the above studies.
This present study found that subjects with sanguine personalities accounted for the least proportion of subjects who completed the trial. Individuals with a more sanguine personalities tend to be emotionally stable, optimistic and less likely to experience negative emotions. So, we hypothesized that patients with a sanguine personality would have a lower risk of AF. The mechanism of personality traits and mental factors causing AF is currently unclear., The most convincing explanation is that mental distress may increase the risk of AF by activating the sympathetic nervous system,[27] inflammatory pathways,[28, 29] hypothalamic-pituitary-adrenal axis and the renin-angiotensin-aldosterone system.[30]
Additionally, we found that patients with a sanguine personality had the highest score in the overall mean AFEQT and AFEQT sub-scale, which is seen as an indicator of treatment effectiveness. A 2012 Korean study showed that type D personality was an independent predictor of impaired Health-Related Quality of Life (HRQOL) for AF patients.[17] After that, the research of Nina's team came to the same conclusion.[16] The type D personality tends to experience negative emotions characterized by depressed mood, anger, anxiety and hostile feelings. Type A behavior refers to several number of personality trait, including impatience, intolerance, and hostility.[31, 32] In our study, sanguine personality assessment by EPQ is contrary, and the QoL was worse in groups with other personality traits. Combining these studies with our results, we find that sunny personalities (such as sanguine personalities) are associated with a better QoL in AF patients, while traits prone to negative emotions (such as choleric, depressive and type D personalities) were associated with impaired QoL. There are many reports that personality traits affect the prognosis of other diseases. Long Gong’s study suggested that sanguine patients undergoing total knee arthroplasty display the best postoperative clinical outcomes undergoing total knee arthroplasty. Whereas, for choleric patients, the satisfaction rate was unexpectedly the lowest.[33] All the evidence supports patients with a sanguine personality show the best clinical outcomes among four types of personalities and that personality traits are risk factors affecting the AFEQT of AF patients. We believe that it is necessary to evaluate the personality of AF patients in advance. This can improve the curative effect of AF therapies by providing psychological counseling treatment as soon as possible.
We also noted great differences in the degree of anxiety and depression for subjects with different personality traits. Patients with the personality trait of negative emotions are also prone to worse QoL. Furthermore, it has been reported that there will be mild in depressive disorders patients with sanguine personality.[34] Our results are consistent with the conclusions of existing studies, which show that anxiety and depression lead to more severe symptoms and poor AFEQT in AF patients.[35] Moreover, anxiety and depression, as the most common negative emotions, are linked to not only the decline of QoL in AF patients,[36] but are also significant risk factors in AF recurrence.[37] These studies and our findings stress the importance of the timing of initiation of psychotherapy in AF patients.
Our research also revealed that gender and CHD are predictors affecting participants' QoL. Compared to males, females tend to have a worse QoL. This idea was supported by Lip GY’s study, in which women demonstrated higher scores of European Heart Rhythm Association (EHRA).[38] The view that CHD makes the QoL worse in AF patients has also been investigated.[39]
The limitations of this study are as follows: 1. This study is a cross-sectional observation. There is a need for prospective design to draw further conclusions about the correlation between personality and AF occurrence and needs a long-term follow-up; 2. The sample size of this study is small, and the findings should be verified further in multi-center clinical trials; 3. Assessment of personality by EPQ was based on a self-reported measure, and it seems not to include the personality of AF patients completely. More suitable assessments of personality traits should be introduced.