Abstract
Purpose: Psychological distress and anxiety are increased among adults with congenital heart disease (CHD). However, heart-focused anxiety (HFA) and its impact on peak oxygen uptake (V[spacing dot above]O2peak) have not yet been studied in this patient cohort. This study investigates HFA in adults with CHD and whether HFA is associated with V[spacing dot above]O2peak in these patients.
Methods: In this cross-sectional study, HFA was assessed in 984 adults with various CHD (34.2 +/- 11.2 yr, 44% female) by the cardiac anxiety questionnaire. In 708 of those (33.5 +/- 10.6 yr, 42% female), additional cardiopulmonary exercise testing was performed to assess exercise capacity by measurement of V[spacing dot above]O2peak.
Results: Compared with the general population, this adult CHD population showed higher HFA in the total cardiac anxiety questionnaire score (z score; 1.32 +/- 1.17; P < .001), as well as in the three subdomains anxiety, avoidance, and attention (all P < .001). The higher the HFA, the lower was the V[spacing dot above]O2peak % predicted (r = -0.280, P < .001) independent of CHD diagnosis, CHD severity, and surgical status. The V[spacing dot above]O2peak % predicted significantly differed between patients with no (85.9 +/- 18.4% predicted), slight (80.4 +/- 18.4% predicted), and severe HFA (74.2 +/- 18.4% predicted) independent of CHD diagnosis, CHD severity, and surgical status (P < .001).
Conclusion: This study shows that HFA is a common sequela in adults with CHD, and high HFA is associated with reduced V[spacing dot above]O2peak. Psychological screening and counseling for HFA therefore seem indicated in the aftercare of adults with CHD.