- Global psychosocial network structure is stable across AF subtypes, EHRA classes, and time, though specific edges and node centralities change.
- Anxiety, general worry, cardiac worry and reduced HRQoL are consistently central; strongest edges link anxiety with general worry and cardiac worry with avoidance.
- Symptomatic patients show increasing loneliness centrality; asymptomatic patients show stronger sleep-HRQoL association; paroxysmal AF had higher node centrality at baseline.
Eur Heart J Open. 2026 Oct 8;6(6):oeag166. doi: 10.1093/ehjopen/oeag166. eCollection 2026 Nov.
ABSTRACT
AIMS: Atrial fibrillation (AF) carries substantial psychosocial burden, but how psychosocial symptoms interrelate across AF subtypes and severities remains unclear. This study compared psychosocial symptom networks across time, AF type, and European Heart Rhythm Association (EHRA) class in the ARENA (Atrial Fibrillation Rhine-Neckar Region) cohort.
METHODS AND RESULTS: Adults with AF were assessed at baseline (T0) and follow-up (T1). Analytic samples included 996 patients with EHRA class [asymptomatic (EHRA 1) vs. symptomatic (EHRA ≥ 2)] and 924 with AF subtype (paroxysmal, persistent, or permanent) data. Measures included anxiety and worry (GAD-2), cardiac worry and avoidance (CAQ-2), health-related quality of life (HRQoL) (EQ-5D-5L), and psychosocial stressors. Gaussian graphical models were estimated and compared using network comparison test. Global network structures were stable across EHRA classes, AF subtypes, and time points, but specific edges and node centralities varied. The most robust edges linked anxiety with general worry and cardiac worry with avoidance. Anxiety, general worry, cardiac worry, and diminished HRQoL were consistently the most central nodes. Among symptomatic (EHRA ≥ 2) patients, loneliness emerged as an increasingly central node over time, whereas among asymptomatic patients (EHRA 1), sleep problems showed a stronger association with HRQoL at follow-up. Atrial fibrillation-type network structures were similar, although paroxysmal networks showed higher node centrality and stronger anxiety-worry coupling at T0; persistent or permanent AF showed a stress-at-home-cardiac worry edge at T1.
CONCLUSION: Psychosocial symptom networks in AF are comparable across subtypes and reveal intervention targets, particularly anxiety, cardiac worry with avoidance, loneliness, and sleep disturbance.
PMID:42991742 | PMC:PMC13739053 | DOI:10.1093/ehjopen/oeag166
Share Evidence Blueprint
Save to Google Notes
Search Google Scholar
Save as PDF
⭐ My Revision List
