Social and psychosocial influences on sudden cardiac death, ventricular arrhythmia and cardiac autonomic function

Abstract

Overall, 88/96 (92%) of identified published studies investigating social and psychosocial aspects of arrhythmic risk were positive. This remarkable consistency across different populations and study designs, lends cautious support to a causal association. Future research: Given the public health and clinical importance of the association between psychosocial factors and arrhythmic risk, further research is required to reconcile important negative findings and address methodological limitations of existing studies and the possibility of publication bias. Complementary studies of populations at low and high risk of arrhythmic events are required. Investigation of social and psychosocial factors in high risk groups - such as patients resuscitated from near sudden death, undergoing electrophysiological studies or with implantable defibrillators - has two main advantages. First, it provides an opportunity of accruing sufficient numbers of arrhythmic events. Second, it allows examination of real life acute psychosocial stressors (for example using diary methods) alongside chronic psychosocial factors measured as continuous variables (e.g. anxiety and depression). High and low risk population studies are required to identify which are the most important psychosocial factors. Existing studies have tended to make many measurements - risking spurious inferences from multiple comparisons - as well as neglecting certain factors e.g. socio-economic status, social supports and psychosocial work characteristics, which may be causally related to coronary heart disease. Further development of appropriate outcome measures indicating arrhythmic activity and threshold and suitable for use in population studies is required. Studies investigating the extent to which social influences on arrhythmic risk can be mitigated by different drug classes are important in identifying the relative importance of different pathways (for example vagal vs sympathetic) as well as potentially offering solutions. Sudden cardiac death is a public health problem yet few agencies have the ability to monitor its occurrence routinely. This should be redressed.