Fear of Recurrence in Atrial Fibrillation Patients: Development of the ECU Fear of Recurrence Scale

Abstract

Atrial fibrillation (AF) is characterized by a rapid and irregular heartbeat that results from abnormal impulse generation from the upper chambers of the heart, the atria. A disorganized heartbeat obstructs the ability of the heart to adequately pump blood through the heart and to other vital organs. Because of this, individuals with AF are at increased risk of adverse health effects including stroke, premature death, and heart failure. Advances in medicine have allowed for treatment developments that target arrhythmic substrate dysfunction and decrease the risk of adverse events. While some AF patients respond effectively to anti-arrhythmic medications, others may require additional interventions to decrease the burden of AF. Given the increased burden among patients who present with sustained AF recurrence rate following intervention, it is plausible that many patients experience significant fear or anxiety related to AF recurrence. The phenomenon of fear of recurrence (FOR) is well-researched in cancer survivors and is often associated with significant psychological and behavioral consequences. The role of FOR among AF patients, however, has not yet been studied despite notable psychological concerns in this population. The present study aimed to determine the overall prevalence and impact of FOR among AF patients through the development of a valid, reliable measure to assess this construct. At the East Carolina Heart Institute (ECHI), 51 patients were recruited to complete the ECU Fear of Recurrence Scale, the Cardiac Anxiety Questionnaire, the ECU Behavioral and Lifestyle Assessment for Atrial Fibrillation, the Fear about Exercise Questionnaire, and the Generalized Anxiety Disorder and Patient Health Questionnaire screeners. Descriptive analyses revealed that the mean age of the sample was 69.71 (SD = 10.12) with 49% identifying as women and the majority identifying their racial/ethnic background as non-Hispanic White (80.4%). Medical and psychological co-morbid conditions were common across the study sample, and health care utilization was high. Major findings of the present study included a) an acceptable degree of reliability ([alpha] = .92) and construct validity for the new measure b) notable prevalence of recurrence fears across the sample c) moderate-high relationships between FOR, cardiac-specific anxiety, and fears about experience and d) evidence of a predictive relationship between AF-specific fears and exercise-related fears. The findings in the present study provide promising evidence for conceptualization and existence of FOR among AF populations and offer a foundation for continuing to address nuance in the patient experience. This measure can likely help to continue to identify patients struggling with adjustment to this condition and aid in future development of targeted interventions to address AF-specific fears.