Clinical and scientific progress related to the interface between cardiology and psychology: lessons learned from 35 years of experience at the Thoraxcenter of the Erasmus Medical Center in Rotterdam.

In November 1975, as the first in the Netherlands, a full-time psychologist was employed at the Department of Cardiology of the Thoraxcenter of the Erasmus Medical Center. This innovative decision was consistent with a view to treat the patient as a whole rather than the heart as a single body part in need of repair, combined with the understanding that the heart and mind interact to affect health. The present selective review addresses the broad range of contributions of 35 years of psychology to clinical cardiology and cardiovascular research with a focus on research, teaching, psychological screening and patient care. The review ends with lessons to be learned and challenges for the future with respect to improving the care and management of patients with heart disease in order to enhance secondary prevention and the role of behavioural and psychological factors in this endeavour.

Encouraging psychological outcomes after altruistic donation to a stranger.

In a growing number of transplant centers worldwide, altruistic donors are accepted to anonymously donate a kidney to a stranger. An important hesitation to expand these transplantation programs is the fear of evoking psychological distress in the altruistic donor after donation. To what extent this fear is justified has not yet been systematically investigated. In this study, 24 altruistic donors were interviewed on average 2 years after donation. Lifetime mental health history, current psychological complaints, satisfaction with and impact of the donation on well-being, motives for donation, communication with recipient and donation experience were assessed. Altruistic donors report a considerable positive impact of donation on psychological well-being, whereas negative impact was limited. Satisfaction with donation was very high. Although a history of a psychiatric diagnosis was ascertained in almost half of the donors, psychological complaints before and after donation were comparable to national average norm scores. Motives for donation were genuine and the experience of donation generally conformed to their expectations. In conclusion, living kidney donation to a stranger does not appear to exacerbate psychological complaints. Moreover, altruistic donors report considerable satisfaction and personal benefit. The exceptional gift of altruistic donors can contribute toward solving the current organ shortage issue.

Altruistic donor triggered domino-paired kidney donation for unsuccessful couples from the kidney-exchange program.

Between January 2000 and July 2009, 132 individuals inquired about altruistic kidney donation to strangers. These donors were willing to donate to genetically and emotionally unrelated patients. Some altruistic donors wished to donate to a specific person, but most wished to donate anonymously. In domino-paired donation, the altruistic donor donates to the recipient of an incompatible couple; the donor of that couple (domino-donor) donates to another couple or to the waiting list. In contrast to kidney-exchange donation where bilateral matching of couples is required, recipient and donor matching are unlinked in domino-paired donation. This facilitates matching for unsuccessful couples from the kidney-exchange program where blood type O prevails in recipients and is under-represented in donors. Fifty-one altruistic donors (39%) donated their kidney and 35 domino-donors were involved. There were 29 domino procedures, 24 with 1 altruistic donor and 1 domino-donor, 5 with more domino-donors. Eighty-six transplantations were performed. Donor and recipient blood type distribution in the couples limited allocation to blood type non-O waiting list patients. The success rate of domino-paired donation is dependent on the composition of the pool of incompatible pairs, but it offers opportunities for difficult to match pairs that were unsuccessful in the kidney-exchange program.

Effect of physical activity after a cardiac event on smoking habits and/or Quetelet index.

OBJECTIVES: To further elucidate earlier findings, the present study investigated whether physical activity could serve as a positive stimulus to modify other changeable cardiac risk factors. METHODS: Participants were 140 patients who had completed a cardiac rehabilitation programme focused on physical activity. Their present level of physical activity, smoking habits and Quetelet index were investigated as well as that before the cardiac event, in retrospect. Current feelings of anxiety and depression were also assessed. Participants were divided into two categories according to their present level of physical activity after finishing the rehabilitation programme, compared with that before the cardiac event. RESULTS: It appeared that the more physically active category contained more smokers. Although many of them had quitted smoking, significantly more persisted in their smoking habits compared with the patients who did not increase their physical activity. Significantly less depression was found in the more active patients. CONCLUSIONS: Although it could not be confirmed that physical activity stimulated a positive change in smoking and Quetelet index, the more active patients appeared to be less depressed.

Development of the Rotterdam Quality of Life Questionnaire for Heart Transplant Recipients.

BACKGROUND: Heart transplantation is a unique and life-threatening event followed by role and lifestyle adjustments, feelings of dependency, and fears about infections and rejection of the donor heart. Generic quality of life measures are unlikely to cover aspects pertinent to transplant recipients. The disease-specific measures available are lengthy and not feasible for use in clinical practice. AIM: The purpose of the current study was to develop a brief and reliable disease-specific instrument to measure quality of life in heart transplant patients. STUDY DESIGN: Survey. METHODS: The Rotterdam Quality of Life Questionnaire for Heart Transplant Recipients was developed according to a series of steps that included in-depth interviews with heart transplant patients, transcription of interviews to form a comprehensive item pool, reduction of the item pool through submission to a panel of healthcare professionals and transplant patients, and further reduction of the item pool through construct formation and statistical analyses. From July to September 2000, all surviving patients (n=237) following heart transplantation at the Erasmus Medical Centre, Rotterdam were asked to fill in the 55-item questionnaire, 205 (86%) of whom replied. RESULTS: Twelve of the 55 original items were identified as contributing to overall quality of life in heart transplant patients based on four à priori selected constructs. Submission of the 12 items to a factor analysis confirmed that the four-factor structure accounted for 62% of the variance. The reliability of the four subscales was adequate. Mean scores on subscales reflected light to moderate impairment in quality of life. CONCLUSION: The Rotterdam Quality of Life Questionnaire for Heart Transplant Recipients is a brief disease-specific instrument that measures quality of life in heart transplant patients. Although further studies are required to elaborate on the psychometric properties of the scale, the preliminary reliability of the scale looks promising.

A multifactorial smoking cessation programme for patients with coronary artery disease: experiences and preliminary results.

BACKGROUND: Smoking is a known risk factor for coronary artery disease (CAD) and recurrent cardiac events in patients with established CAD. Although cessation can lead to a risk reduction of up to 50% following an initial myocardial infarction, at least 20% of cardiac patients continue to smoke. AIMS: To describe and evaluate the effects of a comprehensive, multifactorial smoking cessation programme in outpatients with CAD, and to delineate variables that impede smoking cessation. STUDY DESIGN: Patients with a confirmed diagnosis of CAD recruited from the outpatient cardiology clinic, Dijkzigt University Hospital, Rotterdam, participated in the cessation programme and were followed for three months. Endpoint was smoking cessation. METHODS: Purpose-designed and validated questionnaires were used to assess smoking history, sociodemographic and psychological parameters. Information on cardiac history was sampled from medical records. Height and blood pressure were measured at baseline, and weight and expiratory CO at every group session of the cessation programme. RESULTS: One third of the patients recruited for the programme achieved cessation at three months. Quitters generally smoked less, were less addicted, scored lower on anxiety and depression, and had more recently been diagnosed with CAD. Type D personality was an impediment to cessation (OR:3.50; 95% CI: 0.40-35.48). CONCLUSION: Thirty-two percent of the patients achieved cessation at three months. Cessation efforts should be started in-hospital or as early as possible following diagnosis. An interdisciplinary and multifactorial approach seems warranted, in particular given the negative influence of anxiety, depression, and Type D personality on cessation.

Adverse psychological outcome in women with coronary artery disease.

OBJECTIVES: To investigate gender differences on psychological outcome following cardiac disease, and to identify predictors of psychological distress. METHODS: In total, 536 consecutive cardiac patients ≤70 years were identified from medical records to participate in the study: 36 of them proved to have died since the index event. The mean time since the index event was one year and seven months. Of the 500 patients, 357 (71%) agreed to attend an interview on biomedical risk factors and fill in a psychological questionnaire. Complete psychological data were available for 287 (80%) patients. RESULTS: Women scored significantly higher on anxiety, depression, vital exhaustion and social inhibition, and lower on wellbeing compared with men. Gender, age, percutaneous transluminal coronary angioplasty, smoking and admission for a recurrent event since the index event were independent predictors of psychological outcome. CONCLUSION: These results add to current knowledge on gender differences and show that women have an adverse outcome on a range of psychological variables. This has implications for secondary prevention and rehabilitation. Longitudinal studies are needed to assess the implications of adverse psychological outcome in women on prognosis.