Cardiac anxiety after sudden cardiac arrest: Severity, predictors and clinical implications ☆ Lindsey Rosman a , Amanda Whited a , Rachel Lampert c , Vincent N. Mosesso d , Christine Lawless e , Samuel F. Sears a,b, ⁎ a East Carolina University, Department of Psychology, United States b East Carolina University, Department of Cardiovascular Sciences, United States c Yale University School of Medicine, United States d University of Pittsburgh School of Medicine, United States e Sports Cardiology Consultants, Chicago, IL, United States abstract article info Article history: Received 15 May 2014 Accepted 16 November 2014 Available online 18 November 2014 Keywords: Sudden cardiac arrest Cardiac anxiety Psychosocial adjustment Quality of life Background: Survival from cardiac arrest is a medical success but simultaneously produces psychological challenges related to perception of safety and threat. The current study evaluated symptoms of cardiac-specific anxiety in sudden cardiac arrest (SCA) survivors and examined predictors of cardiac anxiety secondary to cardiac arrest. Methods: A retrospective, cross-sectional study of 188 SCA survivors from the Sudden Cardiac Arrest Association patient registry completed an online questionnaire that included a measure of cardiac anxiety (CAQ) and sociodemographic, cardiac history, and psychosocial adjustment data. CAQ scores were compared to published means from implantable cardioverter defibrillator (ICD), inherited long QT syndrome (LQTS), and hypertrophic cardiomyopathy (HCM) samples and a hierarchical regression was performed. Results: Clinically relevant cardiac anxiety and cardioprotective behaviors were frequently endorsed and 18% of survivors reported persistent worry about their heart even when presented with normal test results. Compared to all other samples, SCA survivors reported significantly higher levels of heart-focused attention (d = 0.3–1.1) and greater cardiac fear and avoidance behaviors than LQTS patients. SCA patients endorsed less severe fear and avoidance symptoms than the HCM sample. Hierarchical regression analyses revealed that younger age (p = 0.02), heart murmur (p = 0.02), history of ICD shock ≥ 1 (p = 0.01), and generalized anxiety (p = 0.008) significantly predicted cardiac anxiety. The overall model explained 29.2% of the total variance. Conclusions: SCA survivors endorse high levels of cardiac-specific fear, avoidance and preoccupation with cardiac symptoms. Successful management of SCA patients requires attention to anxiety about cardiac functioning and security. © 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Advances in resuscitation and medical technology have revolution- ized care and improved survival outcomes for more than 350,000 adults who experience sudden cardiac arrest (SCA) in the United States each year [1]. Although a majority of studies have focused on medical out- comes, the behavioral and psychosocial sequelae of cardiac arrest are a major cause of long-term morbidity and disability among survivors [2–5]. This life-threatening event may also lead some survivors to devel- op disease-specific anxiety or cardiac anxiety, a condition characterized by cardiac specific-fear, avoidance behaviors, and excessive cardiac symptom monitoring [6]. This cluster of symptoms is clinically relevant to cardiology patients, as it has been associated with higher rates of CVD-related distress, avoidance of physical activity, patient-reported disability, and worse perceived health outcomes [6–10]. Cardiac anxiety is equally problematic for health care providers, as patients are more likely to seek medical reassurance for normal alterations in cardiac func- tion, resulting in medically unnecessary emergency department visits, costly diagnostics and procedures, and provider burden [7]. No prior studies have examined the extent to which symptoms are present and predictors of cardiac anxiety in this particular population. Therefore, the purpose of this report is to provide an initial evaluation of the sever- ity of cardiac anxiety in a large cross-section of SCA survivors and iden- tify factors that predict cardiac anxiety following cardiac arrest. International Journal of Cardiology 181 (2015) 73–76 ☆ Funding sources: This work was supported by a research contract with the Sudden Cardiac Arrest Association. The SCAA received grant funds from the Medtronic Foundation in support of this study. ⁎ Corresponding author at: East Carolina University, Department of Psychology, 104 Rawl Hall, Greenville, NC 27858, United States. E-mail address: searss@ecu.edu (S.F. Sears). http://dx.doi.org/10.1016/j.ijcard.2014.11.115 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard