Quality of Life in Heart Transplant Candidates

Research on quality of life with heart transplant patients is complicated by the physical and psychological variables associated with heart failure. This study examined quality of life with several instruments in order to sample more general and more idiosyncratic aspects of quality of life in this particular patient population. We also examined the relationship between various aspects of quality of life and several psychosocial variables, including sensitivity to social desirability effects. The quality of life measures used in this study were found to be significantly correlated with each other and with measures of psychological distress. Implications of these findings are discussed.     

Marital Status and Outcome in Patients with Coronary Heart Disease

The purpose of this study was to examine the relationship of marital status to health outcomes in 818 post-MI, coronary artery bypass surgery, and angioplasty patients (651 males, 157 females) from seven Northern California hospitals who completed 12 months of a nurse-managed, home-based multifactorial risk reduction program. Compared to married patients, nonmarried patients were significantly less likely to complete the program than married patients, more likely to smoke at baseline, and drank significantly less alcohol at baseline. At 12 months there were no significant differences between married and nonmarried groups on smoking cessation rates, HDL, LDL, triglycerides, or exercise treadmill test results. When patients were categorized as married, divorced, separated, widowed, or single, similar results were found for the analyses using two groups (married versus nonmarried), with the following exceptions. Separated patients were significantly less likely to quit smoking. In addition, separated patients showed significantly higher rates of starting (and continuing) to smoke during the time following their MI. Mortality was not significantly different between married and unmarried patients. Implications for intervention with separated patients and the importance of assessing both marital status and marital quality are discussed.     

MMPI Profiles of Liver and Heart Transplant Candidates With and Without Significant Histories of Heavy Alcohol Use

This study compared the Minnesota Multiphasic Personality Inventory (MMPI) profiles of liver and heart transplant candidates with (n = 104) and without (n = 253) significant histories of heavy alcohol consumption. The alcohol and nonalcohol groups had similar overall mean profiles with significant or marginally significant (i.e., T 69) clinical elevations on Scales 1, 2, and 3. However, significantly higher proportions of those in the liver transplant group than in the heart transplant group scored within the clinical range on Scales F, 4, 6, and 8. In addition, the proportions of respondents obtaining clinically elevated scores were significantly higher for the alcohol than for the nonalcohol group on Scale 4 and the MacAndrew Scale; the proportion was higher for the nonalcohol than for the alcohol group on Scale K. The overall similarity of the mean profiles indicates that candidates for liver or heart transplantation with and without histories of heavy alcohol use generally display similar psychological presentations. The observed differences between the liver and the heart transplant groups may reflect impairments in mental status among liver transplant candidates due to metabolic consequences of liver disease. The differences between the alcohol and the nonalcohol groups may be more a reflection of past behavioral patterns than present psychological status.     

Detection of a Psychiatric Diagnosis in Heart Transplant Candidates with the MBHI

The utility of the Millon Behavioral Health Inventory (MBHI) in screening for the formal diagnosis of a psychiatric disorder was investigated in a sample of 90 heart transplant candidates, a population at risk for psychiatric disturbance. Psychiatric disorders were identified in 71% of patients, the majority being adjustment disorder. Sensitivity and specificity rates of >70% were determined in discriminant function analyses, for presence or absence of a psychiatric condition. When Axis I conditions were differentiated as mild (adjustment reaction only) or severe (all other Axis I conditions, including comorbid Axis II disorders), the MBHI correctly identified every severe case as a probable psychiatric diagnosis. The rate of clinically significant elevations on certain MBHI scales and severity of Axis I psychiatric condition was also significantly associated. These findings suggest that the MBHI may have potential utility in identifying high-risk patients with diagnosable psychiatric conditions and help justify mental health consultation referrals at a time when managed care entities are vigorously rationing ancillary services with medically ill populations.     

Stability of heartbeat interval distributions in chronic high altitude hypoxia

Recent studies of nonlinear dynamics of the long-term variability of heart rate have identified nontrivial long-range correlations and scale-invariant power-law characteristics (1/f noise) that were remarkably consistent between individuals and were unrelated to external or environmental stimuli (Meyer et al., 1998a). The present analysis of complex nonstationary heartbeat patterns is based on the sequential application of the wavelet transform for elimination of local polynomial nonstationary behavior and an analytic signal approach by use of the Hilbert transform (Cumulative Variation Amplitude Analysis). The effects of chronic high altitude hypoxia on the distributions and scaling functions of cardiac intervals over 24 hr epochs and 4 hr day/nighttime subepochs were determined from serial heartbeat interval time series of digitized 24 hr ambulatory ECGs recorded in 9 healthy subjects (mean age 34 yrs) at sea level and during a sojourn at high altitude (5,050 m) for 34 days (Ev-K2-CNR Pyramid Laboratory, Sagarmatha National Park, Nepal). The results suggest that there exists a hidden, potentially universal, common structure in the heterogeneous time series. A common scaling function with a stable Gamma distribution defines the probability density of the amplitudes of the fluctuations in the heartbeat interval time series of individual subjects. The appropriately rescaled distributions of normal subjects at sea level demonstrated stable Gamma scaling consistent with a single scaled plot (data collapse). Longitudinal assessment of the rescaled distributions of the 24 hr recordings of individual subjects showed that the stability of the distributions was unaffected by the subject’s exposure to a hypobaric (hypoxic) environment. The rescaled distributions of 4 hr subepochs showed similar scaling behavior with a stable Gamma distribution indicating that the common structure was unequivocally applicable to both day and night phases and, furthermore, did not undergo systematic changes in response to high altitude. In contrast, a single function stable over a wide range of time scales was not observed in patients with congestive heart failure or patients after cardiac transplantation. The functional form of the scaling in normal subjects would seem to be attributable to the underlying nonlinear dynamics of cardiac control. The results suggest that the observed Gamma scaling of the distributions in healthy subjects constitutes an intrinsic dynamical property of normal heart function that would not undergo early readjustment or late acclimatization to extrinsic environmental physiological stress, e.g., chronic hypoxia.     

Gender differences in patterns of emotional distress following heart transplantation

The study provides the first empirical evaluation of gender differences in psychological symptomatology and DSM-III-R major depressive disorder (MDD) across the first year following heart transplantation. An important goal was to identify physical health-related and psychosocial factors that could account for, or mediate, any association between gender and psychological distress. The sample for the present analyses was drawn from a larger cohort of 172 heart recipients and included all 28 women in the cohort plus 118 men who were matched demographically with the group of women. Detailed patient assessments were completed at 2, 7, and 12 months posttransplant. As expected, women's symptom levels were consistently higher than men's. However, while men's symptom levels in all areas declined with time posttransplant, women's distress in the area of depression initially improved but then worsened by the 12-month assessment. The distribution of episodes of MDD showed a temporal pattern of gender differences similar to that of depressive symptoms. The most important mediators of the gender-depression relationship were factors related to early posttransplant daily functional limitations: women reported more impairments in daily activities. Higher levels of such impairments, in turn, predicted subsequently higher depression levels by 12 months posttransplant. Several additional variables pertaining to transplant-related concerns and a low sense of personal mastery—while not serving as mediators—exerted their own independent effects on 12-month depression levels. The findings are relevant to the tailoring of educational and clinical interventions to the individual needs of women and men who receive heart transplants.Roberta G. Simmons, Ph.D., died on February 15, 1993, during data collection for this paper.     

先天性心脏病患儿围手术期心理护理程序研究

为提高先天性心脏病患儿围手术期护理质量,应用心理评估和临床实验方法,对４～１２岁无陪护患儿的心理特点和心理护理程序进行了系列研究。结果发现,先天性心脏病患儿性格较正常儿童内向．情绪不稳定,其智力和适应能力都明显低于正常儿童,根据上述特点确定了围手术期心理护理目标和行为训练等护理方法．通过对１０６例患儿的实验对比观察,提出建构围手术期少理护理程序的理论依据和基本模式．     

Anger and denial as predictors of cardiovascular reactivity in women

The relationship between behavioral and physiological reactivity and cardiovascular disease has been extensively researched in men, indicating that the expression of anger may be a contributory factor in the development of coronary heart disease. Few studies, however, have focused on women. Among these, women generally have been found to be less reactive to laboratory tasks than men. In the present study, 45 women aged 19–21 years were selected to represent three groups—(1) low anger/low denial, (2) high anger/low denial, and (3) low anger/high denial—based on their scores on the State-Trait Anger Expression Inventory and the Marlowe-Crowne Social Desirability Scale. Subjects received three conditions: (1) no feedback, (2) error feedback without observer present, and (3) error feedback with observer present. As hypothesized, women who reported a high level of denial and low anger exhibited elevated stress-related reactivity. The results are suggestive of a subgroup of highly reactive women not previously identified within the literature. The hypothesis that all groups would display greater reactivity in a condition providing error feedback with observation was not supported.This study was supported by a research grant to Carol S. Emerson from the Women's Research Institute of Virginia.     

Coronary-prone behavior may be declining in Danish men and women

Four hundred males and four hundred females were randomly selected from the Danish population and received the Jenkins Activity Survey (JAS) on two occasions, once in 1988 and again in 1992. The JAS was rated by the standard procedure, providing a measure of the degree of time urgency and ambitiousness (Factor A), speed and impatience (Factor S), hard-driving and competitiveness (Factor H) and job involvement (Factor J) shown by the subjects. The scores obtained for all four factors tended to be lower in 1992 than in 1988, and the differences were significant for Factor H. In addition, gender differences were observed for Factors A, S and J, with higher scores being obtained by males than by females. Age-related differences were observed for Factors A and J. The findings indicate that Type A behaviors have declined during the past four years in the Danish adult population and that different strategies may be required for encouraging health behaviors in men and women.     

Modality-repetition and attentional effects on reflex blinking in infants and adults

The ability of a brief prepulse to inhibit reflexively elicited startle is a robust phenomenon in adults of several species but is weak or absent in infants. The possibility that afferent processing of the prepulse is inadequate in infants was tested by assessing the integrity of two other types of reflex modulation that occur in modality-specific paths, that is, attenuation by repetition of same-modality stimuli and enhancement by modality-selective attention. The reflex, measured by electromyographic activity of the muscle controlling blink, was elicited by intense light flashes or noise bursts preceded by brief acoustic or visual prepulses and delivered during attention-directing acoustic or visual foregrounds that evoked cardiac deceleration. Modality-repetition effects were evidenced by smaller peak blink magnitude and longer latency of blinking to same than to different modality pairs and did not differ as a function of age (4-month-old infants or college students). Attention effects were also seen in both infants and adults and, in accord with previous findings, were evident in magnitude for infants and latency for adults. Thus, immaturity in paths mediating these effects could not explain delayed development of prepulse inhibition. Other possibilities include delayed maturation of extrinsic inhibition or of transient-processing systems.