Impact of Anxiety and Depression in Patients with Atrial Fibrillation: Insights from Two International Prospective Registries

BACKGROUND: Limited data are available on the impact of anxiety and/or depression on clinical outcomes in patients with atrial fibrillation (AF). OBJECTIVE: To compare clinical characteristics and outcomes between AF patients with and without anxiety/depression. METHODS: Post-hoc analysis of two prospective registries from Europe and the Asia-Pacific. Patients were classified as asymptomatic or symptomatic for anxiety/depression. The primary outcome was a composite of all-cause death and major adverse cardiovascular events (MACE). Secondary outcomes included all-cause death, MACE, major bleeding, and individual MACE components. Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). Sensitivity analyses were performed by symptom severity and across clinically relevant subgroups. RESULTS: Of 12,614 patients (mean age 69±12 years; 38% female), 4,825 (38.3%) were symptomatic for anxiety/depression (mean age 69±12; 48% female). Symptomatic patients for anxiety/depression were more often female, European, with higher prevalence of AF-related symptoms and heart failure. After a median follow-up of 569 days (IQR 365-735), symptomatic patients had a higher risk of the composite outcome (HR 1.26, 95% CI 1.10-1.45), all-cause death (HR 1.31, 95% CI 1.12-1.55), MACE (HR 1.44, 95% CI 1.19-1.74), and cardiovascular death (HR 1.87, 95% CI 1.41-2.47). Risk increased with symptom severity; no significant interaction was observed by geographic region or other analysed subgroups. CONCLUSION: In patients with AF, anxiety and/or depression symptoms were associated with worse clinical outcomes, with a stronger association observed in those with moderate-to-severe symptoms. These findings highlight the need for greater awareness of psychological assessment within AF management.