Generalized anxiety is a predictor of impaired quality of life in patients with atrial fibrillation: Findings from the prospective observational ARENA study

Monika Sadlonova; Stefan Salzmann; Jochen Senges; Christopher M Celano; Jeff C Huffman; Martin Borggrefe; Ibrahim Akin; Dierk Thomas; Christopher Jan Schwarzbach; Thomas Kleemann; Steffen Schneider; Matthias Hochadel; Tim Süselbeck; Harald Schwacke; Angelika Alonso; Markus Haass; Karl-Heinz Ladwig; Christoph Herrmann-Lingen

doi:10.1016/j.jpsychores.2023.111542

Generalized anxiety is a predictor of impaired quality of life in patients with atrial fibrillation: Findings from the prospective observational ARENA study

J Psychosom Res. 2024 Jan:176:111542. doi: 10.1016/j.jpsychores.2023.111542. Epub 2023 Nov 8.

Authors

Monika Sadlonova¹, Stefan Salzmann², Jochen Senges³, Christopher M Celano⁴, Jeff C Huffman⁴, Martin Borggrefe⁵, Ibrahim Akin⁵, Dierk Thomas⁶, Christopher Jan Schwarzbach⁷, Thomas Kleemann⁸, Steffen Schneider³, Matthias Hochadel³, Tim Süselbeck⁹, Harald Schwacke¹⁰, Angelika Alonso¹¹, Markus Haass¹², Karl-Heinz Ladwig¹³, Christoph Herrmann-Lingen¹⁴

Affiliations

¹ Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany; Department of Cardiovascular and Thoracic Surgery, University of Göttingen Medical Center, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany; Department of Psychiatry, Massachusetts General Hospital, Boston, United States; Department of Psychiatry, Harvard Medical School, Boston, United States. Electronic address: monika.sadlonova@med.uni-goettingen.de.
² Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany; Medical Psychology, Health and Medical University Erfurt, Germany.
³ Institute of Myocardial Infarction Research, Hospital of Ludwigshafen, Ludwigshafen, Germany.
⁴ Department of Psychiatry, Massachusetts General Hospital, Boston, United States; Department of Psychiatry, Harvard Medical School, Boston, United States.
⁵ Department of Cardiology, Pneumology, Angiology, and Emergency Medicine, University of Mannheim Medical Center, Mannheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Germany.
⁶ German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Germany; Department of Internal Medicine III - Cardiology, Angiology and Pneumology, Medical University, Hospital Heidelberg, Germany.
⁷ Department of Neurology, Hospital of Ludwigshafen, Ludwigshafen, Germany.
⁸ Hospital of Ludwigshafen, Ludwigshafen, Germany.
⁹ Clinic of Cardiology, Ludwigshafen, Germany.
¹⁰ Diakonissen-Stiftungs-Hospital Speyer, Speyer, Germany.
¹¹ Department of Neurology, Mannheim Center for Translation Neuroscience, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
¹² Department of Cardiology, Theresien Hospital and St. Hedwig Clinic GmbH, Mannheim, Germany.
¹³ Department of Psychosomatic Medicine and Psychotherapy, University Hospital rechts der Isar, Technical University Munich, Munich, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
¹⁴ Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany.

PMID: 37977094
DOI: 10.1016/j.jpsychores.2023.111542

Abstract

Objective: Atrial fibrillation (AF) is associated with impaired health-related quality of life (HRQoL), an increased risk of morbidity, and mortality. Traditional AF-related outcomes (e.g., AF recurrence) primarily demonstrate the physiological benefits of AF management but do not focus on the benefits experienced subjectively by the patient (i.e., patient-reported outcomes), which have been suggested as optimal endpoints in AF intervention studies. The aim of this study is to identify medical and psychological factors associated with impaired HRQoL at 1-year follow-up.

Methods: Using data from the prospective observational multicenter ARENA study in patients with AF, we analyzed associations between medical factors, anxiety, and HRQoL at 1-year follow-up assessed using 5-level EuroQoL-5D.

Results: In 1353 AF patients (mean age 71.4 ± 10.3 years, 33.8% female), none of the medical predictors (e.g., heart disease) or history of cardioversion were associated with HRQoL at the 1-year follow-up. Higher generalized anxiety (β = -0.114, p < .001) but not cardiac anxiety (β = -0.006, p = .809) at baseline predicted decreased HRQoL, independent of confounding variables and patients' medical status. Furthermore, the worsening of patients' generalized anxiety was associated with decreased HRQoL (ß = -0.091, p < .001). In contrast, the improvement of generalized anxiety over time predicted higher HRQoL (ß = 0.097, p < .001). Finally, the worsening of patients' cardiac anxiety over time was associated with decreased HRQoL (ß = -0.081, p < .001).

Conclusion: Our results highlight the importance of anxiety as a predictor of future HRQoL in patients with AF. Additional studies to examine the impact of anxiety treatment on HRQoL in this population are needed.

Clinical trial registration: The investigators registered on ClinicalTrials.gov (NCT02978248) on November 30, 2016 https://clinicaltrials.gov/ct2/show/NCT02978248.

Keywords: Atrial fibrillation; Cardiac anxiety; Generalized anxiety; Health-related quality of life; Screening.

Publication types

Observational Study
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Anxiety / psychology
Atrial Fibrillation* / complications
Female
Humans
Male
Middle Aged
Patients
Prospective Studies
Quality of Life / psychology

Associated data

ClinicalTrials.gov/NCT02978248

Grants and funding

R01 HL155301/HL/NHLBI NIH HHS/United States