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Psychological factors and risk of atrial fibrillation: A meta-analysis and systematic review

      Highlights

      • Atrial fibrillation (AF) is the most common sustained arrhythmia. Several systematic reviews have emphasized the link between psychological factors (anxiety and depression) and CVD. However, the conclusion about the correlation between psychological factors and AF still remains controversial.
      • In this systematic review and meta-analysis, psychological factors (anxiety, anger, depression and work stress) are found to be associated with increased risk of AF.
      • Several potential pathways are concluded for causality argument between mental disorders and AF.
      • This study suggests that effective interventions preventing mental disorders may decrease the growing global burden of AF and related healthcare cost.

      Abstract

      Background

      Multiple studies have shown that mental disorders are common risk factors for cardiovascular diseases (CVD). However, the relationship between psychological factors and atrial fibrillation (AF) incidence remains unclear. Therefore, we performed a systematic review and meta-analysis to assess the risk of AF due to psychological factors.

      Methods

      PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to January 2022. Relevant and eligible cohort studies were included. Random or fixed effect model was used to estimate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs). For non-randomized studies, the risk of bias was assessed using the Newcastle-Ottawa Scale (NOS).

      Results

      Thirteen publications, including 5,329,908 participants, met our inclusion criteria. The incidence of AF was increased by 10% (HR = 1.10, 95% CI 1.02 to 1.19, I2 = 33.6%, P = 0.013, n = 235,599 in 6 studies) for patients with anxiety, by 15% (HR = 1.15, 95% CI 1.04 to 1.26, I2 = 40.2%, P = 0.04, n = 21,791 in 3 studies) for patients with anger, by 25% (HR = 1.25, 95% CI 1.12 to 1.39, I2 = 57.4%, P < 0.001, n = 5,160,247 in 6 studies) for patients with depression, and by 18% (HR = 1.18, 95% CI 1.05 to 1.32, I2 = 19.2%, P = 0.004, n = 51,664 in 4 studies) for people under work stress.

      Conclusions

      Adverse psychological factors such as anxiety, anger, depression, and work stress may increase the risk of AF. Interventions to prevent mental disorders may reduce the growing global burden of AF and its associated healthcare costs. Given the current study's limitations, our findings need to be further confirmed by a larger prospective study.

      Keywords

      Abbreviations:

      AF (atrial fibrillation), CVD (cardiovascular diseases), HR (hazard ratio), CI (confidence interval), NOS (Newcastle-Ottawa Scale), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)
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      Linked Article

      • Psychological factors as triggers of atrial fibrillation: Seeking for mind-heart connections
        International Journal of CardiologyVol. 364
        • Preview
          Atrial fibrillation (AF) represents the most common sustained cardiac rhythm disorder [1]. Over the last decades, the continuing amelioration of life expectancy and survival of patients with chronic conditions have led to a significant increase in incidence and prevalence of AF [2]. Several investigations have demonstrated that common mental disorders, such as depression and anxiety, are associated with an increased risk of cardiovascular disease [3–5]. However, various controversies regarding the association between psychological factors and risk of AF do remain.
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