Europace Advance Access published online on December 5, 2008
Europace, doi:10.1093/europace/eun332
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CLINICAL RESEARCH
Level of psychosocial impairment predicts early response to treatment in vasovagal syncope
1 Department of Clinical Health Psychology, Royal Victoria Infirmary, Newcastle NE1 4LP, UK; 2 Department of Clinical Psychology, University of Newcastle, Newcastle NE2 4HH, UK; 3 Falls and Syncope Service, Royal Victoria Infirmary, Newcastle NE1 4LP, UK; 4 Institute for Cellular Medicine, University of Newcastle, Newcastle NE2 4HH, UK
Aim: To investigate whether levels of psychosocial impairment and psychological distress at diagnosis in those with vasovagal syncope (VVS) predict subsequent response to conventional treatment.
Methods and results: This is a prospective, observational new patient cohort study, which includes consecutive patients with head-up tilt-confirmed VVS (September 2004–March 2006). Subjects completed the Hospital Anxiety and Depression Scale, State and trait anxiety inventory, and an Adapted Syncope Functional Status Questionnaire at diagnosis and at 3 months. A total of 108 participants [mean (SD) age 52 (21) years, 70.4% were female] completed baseline assessments. Response status was ascertained for 103 individuals; 70 were responders and 33 non-responders. Eighty-three of 103 participants (81%) completed the follow-up questionnaires. At follow-up, compared with responders, non-responders reported higher levels of Impairment (P = 0.001), negative cognitions (P = 0.01), and depression scores (P = 0.006). At diagnosis those who ultimately did not respond to treatment reported significantly higher levels of Impairment (P < 0.001) and negative cognitions (P = 0.03). Those who did not respond to treatment were significantly more depressed (P = 0.001) with higher Trait anxiety scores (P = 0.007). Multivariate analysis confirmed increased impairment predicted poor response status (z = 9.82, P = 0.002) with participants being 3% more likely to be a non-responder with each 1% increase in self-reported level of impairment.
Conclusion: Higher levels of psychosocial impairment reliably predict non-response to treatment, suggesting that psychological factors have an important role in VVS. Screening individuals at diagnosis may enable identification of those at risk of non-response and delivery of targeted psychological interventions to reduce the impact of VVS and its sequelae.
Key Words: Vasovagal syncope, Impairment, Anxiety
* Corresponding author. Tel: +44 191 2824128, Email: julia.newton{at}nuth.nhs.uk
B.F. and C.B. are joint first authors.
Manuscript submitted 10 July 2008. Accepted after revision 12 November 2008.