Put on a Happy Face—It's a Lot Better Than Coumadin

A lthough medical factors predisposing to atrial fibrillation (AF) are well described, whether and how psychosocial factors influence the development of AF remains a nearly unexamined area. In this respect, AF lags far behind other cardiovascular conditions, such as coronary artery disease and ventricular arrhythmia, in which relationships between psychosocial factors and cardiac disease have been well established. Depression predicts the recurrence of ventricular arrhythmia in patients with implantable cardioverter-defibrillators over the long term,1,2 and negative emotions such as anger can acutely trigger ventricular arrhythmias in this population.3 Although the attempts of AF patients to identify psychosocial triggers for their episodes are familiar to all who participate in the care of these patients, to date, large systematic studies evaluating how emotion may affect AF are lacking. There is one small study of 54 AF patients undergoing cardioversion, in which 85% of those scoring high in depression, compared with 39% of those without depression, had a recurrence over the 2month follow-up period.4 In the Framingham study, measures of anger, hostility, and tension predicted development of AF over 10 years in men but not in women.5,6 In this month’s issue of the Journal of the American Heart Association (JAHA), Whang et al7 analyze data from the Women’s Health Study of female health professionals to evaluate whether global distress, as measured by the Mental Health Index (a subset of the Short Form-36), and specific emotional components of distress predict development of AF. This is a large, prospective, well-known study, with long-term followup, a validated instrument for psychosocial evaluation, careful confirmation of the AF outcome, and comprehensive statistical analysis, including adjustment for multiple potential confounders at baseline as well as subsequent cardiac events. In the 30 746 middle-aged women studied, who were free of AF or other cardiovascular disease at baseline, 771 cases of AF