Effect of psychological distress on AF severity

CHAPEL HILL, NORTH CAROLINA. Depression and anxiety are common amongst patients with atrial fibrillation (AF). A group of researchers from the University of North Carolina now reports the results of a study aimed at determining how the presence of depression, anxiety, and imagined physical symptoms (somatization disorder) influences the severity of AF symptoms. Their study included 300 patients with at least 1 documented episode of AF (42% paroxysmal). The average age of the group was 62 years, 66% were male, and most (88.3%) were Caucasian. Most had 1 or more comorbid conditions such as hypertension (56.8%), diabetes (18.7%), coronary artery disease (14.4%), or congestive heart failure (16%).

The study participants completed a total of 7 validated questionnaires designed to quantify the extent of their depression, anxiety, somatization, general health, and AF symptom severity. The following variables were significantly associated with more severe AF symptoms in univariate analysis:

  • Younger age
  • Female gender
  • Being unemployed
  • Having less than high school education
  • Currently suffering from depression
  • Currently suffering from anxiety
  • Currently suffering from somatization disorder
  • Congestive heart failure
  • Smoking

Somewhat surprisingly, AF burden (% of time spent in AF) was not significantly associated with an indication of more severe AF symptoms, whether paroxysmal or persistent. Depression, anxiety, and somatization were all associated with a worsened general health status. In multivariable analysis adjusted for potential confounders (age, gender, ethnicity, working status, education, congestive heart failure, and smoking) increasing severity of depression, anxiety, and somatization symptoms were associated with a worsened general health status and increasing AF-attributed symptom severity. Increasing severity of depression was associated with more frequent visits to seek medical attention for AF.

The researchers conclude that depression, anxiety, and somatization are associated with worsened general well-being and AF-attributed symptoms severity, but also make the statement – “However, it is also plausible that AF leads to the development of psychological distress particularly among patients with inadequate knowledge of their condition and ineffective coping strategies. It has been reported that living with the uncertainty and fear of when another episode will occur will increase psychological distress in patients with other supraventricular arrhythmias.”
Gehi, AK, et al. Psychopathology and symptoms of atrial fibrillation. Journal of Cardiovascular Electrophysiology, Vol. 23, May 2012, pp. 473-78

Editor’s comment: It would seem a reasonable assumption that none of the researchers involved in this study had AF themselves, or had experienced living with someone affected by AF. If they had, they would likely have concluded that severe AF symptoms bring on depression and anxiety rather than that depression and anxiety results in more severe symptoms.