Abstract 129: Severity of Symptoms from Atrial Fibrillation is Associated with Depression and Anxiety: Preliminary Data from the InRhythm Study

Abstract

Background: Atrial fibrillation (AF) affects approximately 4 million Americans, and two out of three AF patients are affected by troublesome symptoms. Symptomatic AF often leads to hospitalization, diminishes quality of life, and imposes considerable stress on affected individuals. Depression and anxiety are exceedingly common in AF, affecting up to one-half of these patients. Nevertheless, few investigations have examined the association between severity and type of AF-related symptoms with depression or anxiety. Methods: A cohort of 113 ambulatory patients treated for symptomatic AF in the University of Massachusetts Medical Center’s AF Treatment Program were assessed for depression using the Patient Health Questionnaire (PHQ), anxiety by the Generalized Anxiety Score (GAD), and health-related quality of life using the Atrial Fibrillation Effect on Quality of Life (AFEQT) as part of an ongoing study of AF treatment and psychosocial factors. We used logistic regression models to examine the association between severity of AF symptoms in four symptom classes (palpitations, dizziness, pauses in heart activity, and irregularity) and severity of depression or anxiety. Results: Participants were 34% female with a mean age of 64 years. Seventy-six percent had paroxysmal AF, and the average AFEQT score was 67 ± 23 (range 0-100, 100 = no disability). Twenty-five percent (n=28) reported moderate or severe anxiety and 40% (n=46) had moderate or severe depression. In multivariable analyses adjusting for age, sex, race, AF type, history of heart failure and coronary artery disease, participants with severe palpitations (23%) and dizziness (25%) were 3 to 5 times more likely to report moderate or severe symptoms of depression and anxiety ( Table , p for all <0.05). Those with severe pauses (9%) and moderate irregularity (29%) were 3 to 7 times more likely to report high depressive symptoms, but not anxiety, than participants with minimal or no symptoms ( Table , p for all <0.05). Conclusion: Participants with AF commonly had symptoms, and the severity of symptoms was positively associated with depression and anxiety. In light of the known association between AF, depression and anxiety, rhythm control strategies such as catheter ablation for AF might improve quality of life as well as symptoms of depression or anxiety.