Heart-Focused Anxiety Is Prevalent in Adults With Congenital Heart Disease and Associated With Reduced Exercise Capacity

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˙ 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˙ 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˙ 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˙ o2peak % predicted ( r = -0.280, P < .001) independent of CHD diagnosis, CHD severity, and surgical status. The V˙ 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˙ o2peak . Psychological screening and counseling for HFA therefore seem indicated in the aftercare of adults with CHD.