TOPLINE:

In patients with atrial fibrillation (AF), anxiety and depression were associated with a higher risk for death and major adverse cardiovascular events and nearly double the risk for cardiovascular mortality, with the highest risk seen in those with more severe symptoms.

METHODOLOGY:

• Evidence on the impact of anxiety and depression on cardiovascular outcomes in AF has been limited. To address this, researchers analysed data from two prospective registries to compare clinical characteristics and outcomes in patients with and without these symptoms across different levels of severity.
• They conducted a post hoc analysis and included 12,614 patients with AF, enrolled consecutively from Europe (2013-2016) and East Asia (2015-2017).
• Patients were categorised as symptomatic (n = 4825) or asymptomatic (n = 7789) on the basis of anxiety and/or depression. The mean age was 69 years for both groups, with more women in the symptomatic group (48% vs 33%).
• Symptoms were assessed using the anxiety or depression domain of the EuroQoL 5D-5L, a validated self-reported instrument, capturing levels of psychological distress rather than a formal clinical diagnosis.
• The primary outcome was a composite of all-cause death and major adverse cardiovascular events, including thromboembolic events, cardiovascular death, and acute coronary syndromes.

TAKEAWAY:

• After adjustments, symptomatic patients had higher risks for the composite outcome (hazard ratio [HR], 1.26; 95% CI, 1.10-1.45), all-cause death (HR, 1.31; 95% CI, 1.12-1.55), major adverse cardiovascular events (HR, 1.44; 95% CI, 1.19-1.74), and cardiovascular death (HR, 1.87; 95% CI, 1.41-2.47) than asymptomatic patients.
• Patients with moderate-to-severe anxiety or depression had the highest risk for the composite outcome (HR, 1.47; 95% CI, 1.22-1.76); however, those with mild symptoms demonstrated a modest but non-significant increase in the risk.
• Symptomatic patients had higher odds of being female (odds ratio [OR], 1.82; 95% CI, 1.65-2.00), AF-related symptoms (OR, 2.10; 95% CI, 1.86-2.38), and heart failure (OR, 1.12; 95% CI, 1.01-1.24) than asymptomatic patients.
• Conversely, symptomatic patients had lower odds of being aged 75 years or above (OR, 0.86; 95% CI, 0.78-0.96), Asian origin (OR, 0.63; 95% CI, 0.56-0.70), and receiving oral anticoagulation (OR, 0.87; 95% CI, 0.77-0.99) than asymptomatic patients.

IN PRACTICE:

"[The study] findings highlight psychological distress as a relevant prognostic marker in AF and support the need for its routine assessment and incorporation into comprehensive, integrated management strategies," the researchers of the study wrote.

SOURCE:

This study was led by Michele Rossi, MD, Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, England. It was published online on June 04, 2026, in Heart Rhythm.

LIMITATIONS:

Due to the observational and post hoc study design, causal relationships between anxiety or depression and cardiovascular outcomes could not be established. Anxiety or depression symptoms were evaluated through self-reported symptoms at enrolment rather than formal clinical diagnoses, which may have introduced misclassification bias. Some patients were excluded due to missing baseline information or incomplete follow-up.

DISCLOSURES:

This study did not receive any funding support. Some authors disclosed receiving consultant or speaker fees along with research grants and serving as consultants, speakers, and principal investigators of research programmes, with no personal fees received. All disclosures were made outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.