Association between Big Five personality traits and participation in cardiac rehabilitation in Japanese patients with cardiovascular disease: a longitudinal study

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI

Background

Cardiac rehabilitation (CR) remains underutilised, despite its established clinical benefit. Assessments of personality traits may serve for patient-medical staff communication to promote CR implementation as they are determinants of health-related behavior. However, few studies have explored the potential effects of the Big Five personality traits on CR participation.

Purpose

This study aimed to examine the association between the Big Five personality traits and CR participation in patients with cardiovascular disease.

Methods

This longitudinal analysis included patients aged <80 years hospitalised for cardiovascular disease. We excluded patients aged ≥ 80 years because of the increased prevalence of the need of assistance for outdoor walking, resulting in non-participation in CR. The Big Five personality traits (conscientiousness, neuroticism, openness, extraversion, agreeableness) of each patient were evaluated using the Japanese version of Ten-Item Personality Inventory at discharge (references: 1, 2). Each patient was also asked to answer a self-administered questionnaire related to outpatient CR. The questionnaire included the will to participate in outpatient CR after discharge (yes or no) and the reasons for non-participation in CR. We examined the frequency of CR attendance for each patient for three months after discharge from medical records. According to the participation frequency, patients were stratified into non-participation, participation, and dropout groups. The participation group was defined as at least one CR session a month within three months after discharge. Patients who did not continue CR for three months were considered dropouts. We examined the relationship of each personality trait with non-participation in CR and dropout within three months using logistic regression analysis.

Results

A total of 139 patients hospitalised for cardiovascular disease were analysed (the mean age: 67.2 ± 9.8 years, men: 71.9%). Of 49 patients who initiated the outpatient CR after discharge, 26 patients continued CR for three months, and 23 patients dropped out. The results of the logistic regression analysis are shown in Figure 1. After adjusted for age, gender, and heart failure, high conscientiousness was associated with non-participation in CR (odds ratio [OR] 1.35, per 1 point; 95% confidence interval (CI) 1.00-1.87). The primary reason for non-participation among patients with high conscientiousness was a lack of motivation. Conversely, low conscientiousness (OR 0.56; 95% CI 0.35-0.90) and high openness (OR 2.19; 95% CI 1.27-3.78) were predictors of dropout within three months after discharge.

Conclusion

The results of this study imply that the Big Five assessment serves for the health communication to improve CR participation. In particular, high conscientious was associated with non-participation in CR due to a lack of motivation, and patients with low conscientiousness and high openness tended to dropout.

Usefulness of the japanese version of rapid dementia screening test for mild cognitive impairment in older patients with cardiovascular disease

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI

Background

Cognitive decline is common among older patients with cardiovascular disease and can decrease their self-management abilities. Therefore, early detection of cognitive decline is clinically important, as it can help guide effective home-based care measures, including education of family members and deployment of healthcare resources. However, the standard instruments for identifying mild cognitive impairment (MCI) are not always feasible in clinical practice.

Purpose

This study evaluated whether MCI could be detected using the Japanese version of the Rapid Dementia Screening Test (RDST-J), which is a simple screening tool for identifying cognitive decline.

Methods

This cross-sectional study included patients who were ≥ 65 years old and hospitalised because of cardiovascular disease. Patients with a pre-hospitalisation diagnosis of dementia were excluded. Each patient’s cognitive function had been measured at discharge using the RDST-J and the Japanese version of the Montreal Cognitive Assessment (MoCA-J), which is a standard tool for MCI screening. The RDST-J includes a number transcoding task and a supermarket task, and can be completed in 3 min (range: 0–12 points). The MoCA-J assesses nine domains of cognition and requires 10–15 min to complete (range: 0–30 points). The correlation between the two scores was evaluated using Spearman’s rank correlation coefficient. Receiver operating characteristic (ROC) analysis was also conducted to evaluate whether the RDST-J could identify MCI, which was defined as a MoCA-J score of ≤ 25 points.

Results

The study included 78 patients (the mean age: 77.2 ± 8.9 years, men: 56.4%). Based on a MoCA-J score of ≤ 25 points, MCI was identified in 73.1% (n = 57) of the patients. The RDST-J and MoCA-J scores were strongly correlated (r = 0.835, p <0.001). The ROC analysis revealed that an RDST-J score of ≤ 9 points provided 75.4% sensitivity and 95.2% specificity for identifying MCI, with an area under the curve of 0.899 (95% confidence interval: 0.835–0.964, Figure 1). The same cut-off value was identified when excluding patients with a high probability of dementia (RDST-J score of ≤ 4 points).

Conclusions

The RDST-J is a simple instrument and its score was highly correlated with the standard test for identifying MCI in older patients with cardiovascular disease. Our results suggest that the RDST-J may be useful for routine cognitive assessments in clinical practice. Longitudinal studies are needed to evaluate whether the RDST-J scores respond to changes in cognitive status, as well as whether this tool can be used to predict adverse health outcomes after discharge.

Association between coordination of long-term care insurance service and adverse outcome after discharge in older patients with heart failure

Funding Acknowledgements

Type of funding sources: None.

Introduction

Long-term care insurance (LTCI) has a key role in the disease management of older patients in Japan. However, clinical benefit of coordinating LTCI service during hospitalization has not been examined in patients with heart failure (HF).

Purpose

We aimed to examine the association between the coordination of LTCI service and adverse outcome after discharge in Japanese older patients with HF.

Methods

The inclusion criteria of this retrospective cohort study were patients aged ≥ 65 years hospitalised for HF who used any LTCI services after discharge. In Japan, people aged ≥ 65 who satisfy the eligibility criteria are eligible to receive LTCI services. Questionnaires regarding daily life and activities are used to assess eligibility and create the 7 certification levels: support required 1 or 2, and care levels 1 (least disabled) to 5 (most disabled). In this study, patients were divided into 1) patients without any change in LTCI service during hospitalisation (Group N), 2) patients with coordination of LTCI services during hospitalization (Group C), 3) patients who newly initiated LTCI service after discharge (Group I). The primary outcome was a composite of HF rehospitalisation and all-cause mortality. Survival rate was compared using Kaplan-Meier curve analysis and log-rank test. Multivariate analysis was conducted using Cox proportional-hazards model adjusted for propensity score calculated based on age, gender, brain natriuretic peptide, β-blocker, angiotensin converting enzyme inhibitor /angiotensin II receptor blocker, need of any walking device or assistance at discharge, living alone, LTCI level.

Results

A total of 135 older patients were included (mean age 84 years, men 46%). During the median follow-up of 580 days, 43 events occurred. The number of patients for each group was as following: Group N, n = 91; Group C, n = 20; Group I, n = 24. The survival rates were significantly different among the three groups (log-rank test p = 0.039 , Figure 1). In Cox proportional-hazards model with Group N as a reference, Group C was associated with reduced risk of the study outcome (hazard ratio 0.22, 95% confidence interval 0.05-0.91, p = 0.036). Group I also showed lower event rate but not statistically significant (hazard ratio 0.81, 95% confidence interval 0.20-0.30, p = 0.756). All the patients in Group C used visiting nurse service, whereas the implementation rates were 12.1% and 37.5% in Group N and Group I, respectively. Implementation rate of visiting rehabilitation was higher in Group C (20.0%) compared to Group N (1.1%) and Group I (4.2).

Conclusions

Patients with coordination of LTCI service during HF hospitalization showed reduced risk of adverse outcome after discharge, implying the clinical benefits of utilization of LTCI service. Further large-scale studies are needed to examine the optimal utilization of tailor-made LTCI service according to the patient’s condition.

Plasma resistin concentration determined by common variants in the resistin gene and associated with metabolic traits in an aged Japanese population

AIMS/HYPOTHESIS

Resistin is a cytokine derived from adipose tissue and is implicated in obesity-related insulin resistance and type 2 diabetes mellitus. Polymorphisms of the resistin gene (RETN) have been shown to affect the plasma resistin concentration. The aims of this study were to identify polymorphisms of RETN that influence plasma resistin concentration and to clarify the relation between plasma resistin level and metabolic disorders in an aged Japanese cohort.

METHODS

The study participants comprised 3133 individuals recruited to a population-based prospective cohort study (KING study). Plasma resistin concentration, BMI, abdominal circumference, blood pressure, fasting plasma glucose and serum insulin concentrations, HbA(1c) content and serum lipid profile were measured in all participants. The HOMA index of insulin resistance (HOMA-IR) was also calculated. Eleven polymorphisms of RETN were genotyped.

RESULTS

A combination of ANOVA and multiple linear regression analysis in screening and large-scale subsets of the study population revealed that plasma resistin concentration was significantly associated with rs34861192 and rs3745368 polymorphisms of RETN. Multiple linear regression analysis with adjustment for age and sex also showed that the plasma resistin level was significantly associated with serum concentrations of HDL-cholesterol, triacylglycerol and insulin, as well as with BMI.

CONCLUSIONS/INTERPRETATION

Our results implicate the rs34861192 and rs3745368 polymorphisms of RETN as robust and independent determinants of plasma resistin concentration in the study population. In addition, plasma resistin level was associated with dyslipidaemia, serum insulin concentration and obesity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00262691.