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˙o_2peak) have not yet been studied in this patient cohort. This study investigates HFA in adults with CHD and whether HFA is associated with V˙o_2peakin 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˙o_2peak. 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˙o_2peak% predicted (r = -0.280, P <.001) independent of CHD diagnosis, CHD severity, and surgical status. The V˙o_2peak% 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˙o_2peak. Psychological screening and counseling for HFA therefore seem indicated in the aftercare of adults with CHD.