Predictors of persistent palpitations and continued medical utilization.
BACKGROUND
The aim of this study was to determine the predictors of persistent palpitations and continued medical utilization in a sample of medical patients referred for ambulatory electrocardiographic monitoring.


METHODS
A prospective telephone follow-up was conducted with patients who had undergone ambulatory electrocardiographic monitoring 3 months earlier. At inception, patients completed in-person interviews and self-report questionnaires, assessing somatization, hypochondriacal attitudes, bodily amplification (high degree of sensitivity to bodily sensations), and two types of life stress (minor daily irritants and major life changes). At follow-up, patients completed a structured interview about their clinical course, palpitations, and utilization of medical care during the interval.


RESULTS
At 3-month follow-up, 55 of the inception cohort of 67 patients were interviewed again. The mean severity of palpitations for the entire sample declined significantly, but 46 (83.6%) patients continued to experience their presenting symptoms. Stepwise multiple linear regression revealed that the interaction of bodily amplification and daily life stress at inception uniquely explained 10.0% of the variance in palpitation severity at follow-up. A four-step model composed of these two interaction terms and age and education level accounted for 21.4% of the variance in palpitations. The medical utilization findings are complementary in that the interaction of amplification and daily irritants at baseline predicted the number of unscheduled medical visits over the subsequent 3 months. The total number of ventricular premature contractions occurring during ambulatory monitoring was not a significant predictor of palpitations.


CONCLUSIONS
Palpitations are more persistent in persons who are both highly sensitive to bodily sensations and who experience a greater number of minor daily irritants. The existence of either predictor alone is not sufficient to perpetrate this functional somatic symptom; it requires the combination of these predictors.
Barsky
A J
AJ
Division of Psychiatry, Brigham and Women's Hospital, Boston, MA 02115, USA.
Ahern
D K
DK
Bailey
E D
ED
Delamater
B A
BA
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000523:psychology; D018880:Atrial Premature Complexes / Q000175:diagnosis; D002908:Chronic Disease; D003710:Demography; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D006998:Hypochondriasis / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013315:Stress, Psychological