The effect of anxiety and depression on symptoms attributed to atrial fibrillation.
BACKGROUND
Symptoms attributed to atrial fibrillation (AF) are nonspecific, and it remains unclear what influences perception of symptoms. Anxiety or depression may be important in modulating perception of AF symptoms. However, few longitudinal studies have addressed this effect.


METHODS
A total of 378 patients with AF completed anxiety and depression severity questionnaires as well as AF symptom and frequency severity questionnaires. Patients were offered treatment strategies including catheter ablation or antiarrhythmic or rate-controlling medications. Patients were followed at 3-month intervals and completed follow-up questionnaires including repeat assessment of anxiety, depression, and AF symptoms. A method of generalized estimating equations was used for longitudinal analyses.


RESULTS
Analysis revealed that increased anxiety or depression was associated with increased AF symptom severity (AFSS), after adjusting for potential confounders. In both unadjusted and adjusted follow-up analyses, antiarrhythmic drug therapy or catheter ablation reduced AFSS (P < 0.001). However, none of anxiety severity, depression severity, or the perception of AF frequency severity improved significantly with AF treatment.


CONCLUSIONS
Our results extend previous studies demonstrating that anxiety and depression are associated with worsened AFSS. Antiarrhythmic drug therapy or catheter ablation reduces AFSS but does not affect depression and anxiety symptoms. To achieve more comprehensive AF symptom relief, treatment of both AF and psychological comorbidities may be beneficial.
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Tiffany S
TS
Thompson
Debra J
DJ
Barksdale
Samuel F
SF
Sears
John Paul
JP
Mounsey
Irion
I
Pursell
Anil K
AK
Gehi
D017677:Age Distribution; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology*; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy*; D017115:Catheter Ablation / Q000523:psychology / Q000706:statistics & numerical data; D015984:Causality; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D012307:Risk Factors; D017678:Sex Distribution; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents
anxiety; atrial fibrillation; depression; quality of life