AF patients with high cardiac anxiety had significantly greater AF-specific healthcare use, including more visits, hospitalizations, and procedures (P=0.03) than those with low anxiety.
Does high cardiac anxiety increase healthcare utilization in patients with atrial fibrillation?
High cardiac anxiety in patients with atrial fibrillation is associated with significantly increased AF-specific healthcare utilization.
Abstract Background Atrial fibrillation (AF) is a leading cause of hospitalizations and healthcare costs. Up to 20% of AF patients suffer from cardiac anxiety - a debilitating psychiatric syndrome that is characterized by intense cardiac fear, excessive symptom monitoring, and avoidance behaviors. Cardiac anxiety may lead AF patients to seek more frequent medical care. Purpose This study was designed to compare AF-specific healthcare utilization among patients with AF who reported high versus low cardiac anxiety. Methods In this retrospective, propensity-matched study of 172 patients with AF, self-report questionnaires and electronic health record data were merged to examine differences in AF-specific healthcare use (outpatient and inpatient encounters, rhythm-related testing, and procedures) and informal healthcare use (patient portal messages and telephone calls) over a 9-month period. Patients were stratified into tertiles by scores on the Cardiac Anxiety Questionnaire (CAQ), which includes 18 items that are rated on a 5-point Likert scale (0=never to 4=always). A high score indicates a greater number of symptoms, greater frequency of symptoms, or both. A high CAQ score was defined as above the second tertile and a low CAQ score was defined as below the first tertile. Healthcare use was compared among those with high and low cardiac anxiety. Propensity score matching was based on demographics, AF pattern (paroxysmal, persistent, atrial flutter), socioeconomic status, CHA2 DS2-VASc score, and history of rhythm control treatment. For each group, linear regression was used to calculate the mean and 95% confidence intervals. Results Of the 172 AF patients in overall cohort, 43 patients had high cardiac anxiety (mean CAQ: 1.95, SD: 0.2) while 42 patients had low cardiac anxiety (mean: CAQ 0.74, SD: 0.19). Individuals with high cardiac anxiety were more likely to be male and have prior diagnoses of diabetes, coronary artery disease, chronic obstructive pulmonary disorder, hypertension, and depression than those with low anxiety (ps0.05). After matching, AF-specific health care use was significantly greater among patients with high cardiac anxiety compared to those with low symptoms (P=0.03), including a higher prevalence of department visits, hospitalizations, outpatient cardiology visits, and procedures (EKG, ECHO, TEE). Yet, there were no differences in the use of informal health care resources (telephone calls or patient portal messages to cardiology clinics). Conclusions In this cohort of AF patients, more severe cardiac anxiety was associated with greater rates of AF-specific healthcare utilization, including inpatient and outpatient encounters and procedures, compared to those with less cardiac anxiety. Future studies need to replicate our findings and examine the downstream effects of cardiac anxiety on AF healthcare costs and provider burden. This work will support the development of interventions to reduce cardiac anxiety in patients with AF.
Gaffey et al. (2025) studied this question. AF patients with high cardiac anxiety had significantly greater AF-specific healthcare use, including more visits, hospitalizations, and procedures (P=0.03) than those with low anxiety.