Atrial Fibrillation: Bad for the Heart and the Soul

January 9, 2014

An observational study of patients with atrial fibrillation suggests that routine screening for depression at office visits may help augment treatment.

Depressive symptoms may be higher in patients with atrial fibrillation (AF) according to a population study of 10,000 individuals (mean age 56 ±11 years; 49.4% women) recently published in PLoS One. This was an observational study of the population-based Gutenberg Healthy Study in which depressive symptoms were self-reported, assessed by the Patient Health Questionnaire (PHQ-9) and assigned a score.

There were 309 patients in the cohort who had a previous history of depression. The median depressive symptom score was higher (4 vs 3) in those with AF compared with those without, and the effect persisted even after multivariable regression analysis. Although modest, the adjusted OR for the severity of depressive symptoms was 1.04 (95% CI, 1.01-1.08) and statistically significant; results did not change after adjusting for additional comorbidities, such as heart failure, for inflammatory markers, and for sociodemographic factors. Depressive symptoms were driven more by somatic symptom dimensions than by cognitive ones. In addition, patients with AF were more likely to report statistically lower physical health status (adjusted OR = 0.54; 95% CI, 0.41-0.70 for very good/good vs fair/bad) and lower mental health status (adjusted OR = 0.61; 95% CI, 0.46-0.82).

The study results suggest that AF, which has long been recognized as a chronic illness with rising prevalence worldwide, may also have an impact on mental health and perception of physical health. The mechanism to explain these results remains unclear. These findings carry significant public health implications, raising the question of whether all patients with AF should be screened for depression at office visits.

References:

Schnabel RB, Michal M, Wilde S, Wiltink J, Wild PS, et al. Depression in atrial fibrillation in the general population. PLoS ONE. 2013;8:e79109. Published online December 4, 2013. doi:10.1371/journal.pone.0079109. Full text available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850915/