[The role of psychosocial risk factors in the development and course of atrial fibrillation].

BACKGROUND

Psychosocial risk factors are well established in the development of cardiovascular disease. However, their role in the onset and progression of atrial fibrillation (AF) has not yet been systematically summarised.

OBJECTIVE

To present the current evidence on psychosocial risk factors associated with the development and course of AF.

METHODS

A scoping review of epidemiological and population-based studies as well as relevant meta-analyses was conducted. Studies addressing psychosocial risk factors, including social, occupational, and psychological stressors, sleep disturbances, depression, anxiety disorders, and stress-related disorders were included.

RESULTS

Consistent associations were reported particularly for depression, insomnia, and work-related stress. For depression, risk increases ranging from 15% to 58% were reported. Large population-based cohort studies consistently demonstrated risk increases of 26% to 36% for insomnia. In addition, associations were observed for adverse childhood experiences, anxiety disorders, and post-traumatic stress disorder. Evidence regarding loneliness and social isolation was inconsistent. Proposed underlying mechanisms include autonomic, endocrine, and inflammatory pathways.

CONCLUSION

Available evidence suggests that psychosocial factors make a relevant contribution to the development and maintenance of AF. Consideration of psychosocial stressors may complement current approaches to AF risk stratification and prevention. The existing evidence supports a stronger integration of psychosocial risk factors into future epidemiological research and clinical care concepts.