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Research Article: Effect of anti-anxiety therapy on the prognosis of patients with atrial fibrillation and anxiety: a 2?×?2 factorial randomized controlled trial

Date Published: 2026-07-07

Abstract:
Atrial fibrillation (AF) and anxiety frequently co-occur, significantly impairing quality of life (QoL) and potentially worsening prognosis. However, integrated psychological management in AF care remains insufficient, with scarce evidence on combined pharmacotherapy and psychological interventions. This single-center, randomized controlled trial employed a 2?×?2 factorial design to evaluate the efficacy of combined anti-anxiety therapy [escitalopram and Cognitive Behavioral Therapy (CBT)] in 120 patients with AF and anxiety (GAD-7???10). Participants were allocated to one of four groups: Drug Therapy, Psychological Intervention (CBT), Combination (Drug?+?CBT), or Control (routine care). The primary endpoint was the change in QoL (SF-36 questionnaire) at 3 and 6 months, and the secondary endpoint was the incidence of Major Adverse Cardiovascular Events (MACE). A total of 117 patients completed the follow-up. At 6 months, significant improvements were observed in the Role-Physical (RP), General Health (GH), Vitality (VT), and Social Functioning (SF) domains of the SF-36 in the intervention groups compared to the control group (all P <?0.01). Factorial analysis of the GH score change confirmed significant main effects for both psychological intervention ( P <?0.001) and drug therapy ( P =?0.011), with no significant interaction, indicating additive benefits. The Combination group also demonstrated a significantly lower overall incidence of MACE at 6 months compared to the Control group (36.67% vs. 70.00%, P =?0.003). This study demonstrates that combined anti-anxiety pharmacotherapy and psychological therapy improves QoL and reduces cardiovascular risk in patients with AF and anxiety.

Introduction:
Atrial fibrillation (AF) and anxiety frequently co-occur, significantly impairing quality of life (QoL) and potentially worsening prognosis. However, integrated psychological management in AF care remains insufficient, with scarce evidence on combined pharmacotherapy and psychological interventions.

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