Sensitivity to Bodily Symptoms of Anxiety May Make a Difference in Treatment

Photo: Man with fear in his face

Anxiety can change harmless symp-
toms to signs of impending doom;
© panthermedia.net JCB Prod

Heart and Stroke Foundation researcher and lead author Doctor Nancy Frasure-Smith explained that anxiety sensitivity is the degree to which a person is frightened by bodily sensations and symptoms, particularly those associated with anxiety.

"For most people, sweaty palms and an increasing heart rate are simply unpleasant symptoms that occur in stressful situations, for others these same symptoms are interpreted as a sign of impending doom," says Frasure-Smith. "People with high anxiety sensitivity tend to magnify the potential consequences of their anxiety symptoms, leading to an increase in anxiety and its symptoms in a spiralling increase of fear and worry."

While anxiety sensitivity is known to predict the occurrence of panic attacks in cardiac and non-cardiac patients, and is associated with greater symptom preoccupation and worse quality of life in patients with AF, it has not been previously studied as a predictor of cardiac outcomes.

These results are based on a sub-study from the Atrial Fibrillation and Congestive Heart Failure Trial (AF-CHF), a randomized trial of rhythm versus rate control treatment strategies whose results were presented at the Canadian Cardiovascular Congress in 2008. Prior to randomization 933 AF-CHF study participants completed a paper and pencil measure of anxiety sensitivity. They were then randomly placed in one of two treatment groups: a 'rhythm' group that was treated with anti-arrhythmic medication and cardioversion (an electric shock to convert an abnormal heart rhythm back to normal rhythm); and a 'rate' group that received medication to help keep people's heart rates within a certain range.

Participants were followed for an average of 37 months. Results showed that, as in the overall AF-CHF trial, the majority of patients had as good a prognosis with the rate control strategy as with the rhythm control approach. In contrast, patients with high anxiety sensitivity had significantly better outcomes if they were treated with the more complicated rhythm control strategy.

"Increased emotional responses to AF symptoms in people with high anxiety sensitivity may lead to increased levels of stress hormones making them more vulnerable to fatal arrhythmias and worsening heart failure," says Frasure-Smith. "For AF-CHF patients with high anxiety sensitivity maintenance of normal sinus rhythm appears to be important."

"While the study − a sub analysis of a larger trial – is not definitive in itself, it does raise interesting questions," says Heart and Stroke Foundation spokesperson Doctor Beth Abramson. We tend to underestimate the power of the mind in patients on powerful heart medications. Mental well being however is an important aspect of care for all heart patients."

MEDICA.de; Source: Heart and Stroke Foundation of Canada