title: Anxiety sensitivity moderates prognostic importance of rhythm-control versus rate-control strategies in patients with atrial fibrillation and congestive heart failure: insights from the Atrial Fibrillation and Congestive Heart Failure Trial.
abstract: BACKGROUND
  Patients with high anxiety sensitivity (AS) become extremely anxious with heart rate increases, palpitations, and symptoms of psychological arousal. AS predicts panic attacks. In atrial fibrillation (AF), AS correlates with symptom preoccupation and reduced quality of life. We assessed whether AS is associated with outcomes of rhythm-control versus rate-control in congestive heart failure (CHF) patients with AF.
  
  
  RESULTS
  Before random assignment, 933 participants (172 women) in the Atrial Fibrillation and Congestive Heart Failure Trial completed the Anxiety Sensitivity Inventory (ASI). Cox proportional hazards models showed no main effects of treatment (P=0.61) or AS (P=0.72) for time to cardiovascular death, but these factors interacted significantly (P=0.020). High AS patients (upper quartile, ASI ≥33) randomly assigned to rhythm-control had significantly lower cardiovascular mortality than those receiving rate-control (hazard ratio, 0.54; 95% confidence interval, 0.32-0.93; P=0.022). With lower ASI scores (<33), treatments did not differ (hazard ratio, 1.12; 95% confidence interval, 0.83-1.51; P=0.46). The interaction between treatment and dichotomized ASI scores remained significant (P=0.009) after adjustment for covariates including age, sex, hypertension, diabetes, creatinine, ejection fraction, time since first diagnosis of AF, New York Heart Association functional class, depression symptoms, marital status, and baseline β-blockers, angiotensin-converting enzyme inhibitors, oral anticoagulants, and implantable cardioverter-defibrillators.
  
  
  CONCLUSIONS
  Atrial fibrillation and congestive heart failure patients with high AS had better long-term prognosis with rhythm- than rate-control. If replicated, AS should be considered in treatment selection. Research is also needed concerning mechanisms and possible joint AS-AF treatments.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT88597077.
authors.affiliation: Heart Institute Research Centre, 5000 Bélanger, Montreal, Quebec, Canada H1T 1C8. nancy.frasure-smith@umontreal.ca
authors.forename: Nancy
authors.initials: N
authors.lastname: Frasure-Smith
authors.forename: François
authors.initials: F
authors.lastname: Lespérance
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.forename: Eileen
authors.initials: E
authors.lastname: O'Meara
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality* / Q000523:psychology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000209:etiology; D010551:Personality; D011379:Prognosis; D016016:Proportional Hazards Models; D011788:Quality of Life / Q000523:psychology; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000889:Anti-Arrhythmia Agents