Burnout tied to increased AF risk

Greater levels of vital exhaustion, or burnout, are associated with an increased risk of developing atrial fibrillation (AF), suggests the ARIC* study.

“Vital exhaustion, commonly referred to as burnout syndrome, is typically caused by prolonged and profound stress at work or home,” said lead author Dr Parveen Garg from the University of Southern California Keck School of Medicine in Los Angeles, California, US.  

“It differs from depression, which is characterized by low mood, guilt, and poor self-esteem. The results of our study further establish the harm that can be caused in people who suffer from exhaustion that goes unchecked,” he explained.

Using the Vital Exhaustion Questionnaire to measure burnout levels, the researchers found that participants in the highest quartile were 45 percent more likely than those in the reference group at the lowest quartile to develop AF (hazard ratio [HR], 1.45, 95 percent confidence interval 1.29–1.64). [Eur J Prev Cardiol 2020;doi:10.1177/2047487319897163]

The association remained significant after adjusting for age, sex, height, race-centre, and education, height, as well as after further adjustment for relevant comorbidities (HR, 1.20, 95 percent CI, 1.06–1.35).

“It is already known that exhaustion increases one’s risk for cardiovascular disease, including heart attack and stroke. We now report that it may also increase one’s risk for developing AF, a potentially serious cardiac arrhythmia,” said Garg.

“The importance of avoiding exhaustion through careful attention to — and management of — personal stress levels as a way to help preserve overall cardiovascular health cannot be overstated,” he highlighted.

The prospective cohort study included 11,445 participants (mean age 57 years, 56 percent female) who did not have AF at baseline. They were assessed on several psychosocial measures such as vital exhaustion, anger, and social ties, which are indicative of underlying distress. Use of antidepressants was also recorded, as a proxy for mental disorders.

During a median follow-up period of 23.4 years, there were 2,220 cases of incident AF.

While the use of antidepressants was also associated with a greater risk of developing AF (HR, 1.37, 95 percent CI, 1.11–1.69), the association became nonsignificant after further adjustment for relevant comorbidities.

In addition, there were no significant associations between poor social ties or anger with incident AF.

Unlike depression, feelings of guilt and low self-esteem are largely absent in vital exhaustion, which is characterized by excess fatigue and loss of vigour, according to the researchers.

“Vital exhaustion is associated with increased inflammation and heightened activation of the body's physiologic stress response,” Garg said. “When these two things are chronically triggered, that can have serious and damaging effects on the heart tissue, which could then eventually lead to the development of this arrhythmia.”

He also cautioned that the magnitude of the association between burnout and AF risk was modest in the study and thus, statistical significance does not necessarily translate to clinical relevance.

“Ultimately, determining whether targeted efforts to improve the identification and treatment of these individuals actually reduces AF incidence and obtaining a better understanding of how these therapeutic interventions might modify risk will be most important,” the researchers said.