Christoph Herrmann-Lingen

Aims: Atrial fibrillation (AF) carries substantial psychosocial burden, but how psychosocial symptoms interrelate across AF subtypes and severities remains unclear. This study compared psychosocial symptom networks across time, AF type, and European Heart Rhythm Association (EHRA) class in the ARENA (Atrial Fibrillation Rhine-Neckar Region) cohort. Methods and results: Adults with AF were assessed at baseline (T0) and follow-up (T1). Analytic samples included 996 patients with EHRA class [asymptomatic (EHRA 1) vs. symptomatic (EHRA ≥ 2)] and 924 with AF subtype (paroxysmal, persistent, or permanent) data. Measures included anxiety and worry (GAD-2), cardiac worry and avoidance (CAQ-2), health-related quality of life (HRQoL) (EQ-5D-5L), and psychosocial stressors. Gaussian graphical models were estimated and compared using network comparison test. Global network structures were stable across EHRA classes, AF subtypes, and time points, but specific edges and node centralities varied. The most robust edges linked anxiety with general worry and cardiac worry with avoidance. Anxiety, general worry, cardiac worry, and diminished HRQoL were consistently the most central nodes. Among symptomatic (EHRA ≥ 2) patients, loneliness emerged as an increasingly central node over time, whereas among asymptomatic patients (EHRA 1), sleep problems showed a stronger association with HRQoL at follow-up. Atrial fibrillation–type network structures were similar, although paroxysmal networks showed higher node centrality and stronger anxiety–worry coupling at T0; persistent or permanent AF showed a stress-at-home–cardiac worry edge at T1. Conclusion: Psychosocial symptom networks in AF are comparable across subtypes and reveal intervention targets, particularly anxiety, cardiac worry with avoidance, loneliness, and sleep disturbance.

Background: The Hospital Anxiety and Depression Scale (HADS) is a widely used instrument for assessing anxiety and depression in cancer patients. However, the best factor structure for an oncological setting depending on the time of diagnosis is still unclear. Aim: The objective of this study was to investigate the factor structure of the German‐language version of the HADS in order to review the use of the HADS subscales and the HADS total scale in standard psycho‐oncological care for cancer patients. Method: A secondary data analysis of N = 3395 cancer patients receiving psycho‐oncological care was conducted to analyze 22 of the most common HADS factor models from the literature using confirmatory factor analysis. Confirmatory factor analysis was performed using weighted least squares with mean and variance adjustment (WLSMV). Additionally, measurement invariance (MI) analysis was conducted. Results: The results indicate that two bifactorial models (Bifactor Model 1: higher‐order factor + Anxiety and Depression subscale; Bifactor Model 2: higher‐order factor + Restlessness, Anxiety, and Depression subscale) exhibit better quality than the original two‐factorial structure (independent anxiety and depression scales) of the HADS (CFI: original structure = 0.970–0.971; Bifactor Model 1 = 0.987–0.988; Bifactor Model 2 = 0.990–0.991; TLI: original structure = 0.964–0.966; Bifactor Model 1 = 0.982; Bifactor Model 2 = 0.985–0.986; RMSEA: original structure = 0.082–0.086; Bifactor Model 1 = 0.065; Bifactor Model 2 = 0.053–0.054). The MI analysis revealed significant differences in performance between configural, metric, and scalar invariance for all three models. Conclusion: The results support the use of a bifactorial factor structure for the HADS‐D, with the original Anxiety and Depression factors/scales operationalized, as well as an overarching factor in the form of the total sum score.

Purpose: Quality of Life (QoL) is a key outcome in adults with congenital heart disease (ACHD). While the WHOQOL-BREF is broadly applied, its psychometric properties have not been systematically assessed in German-speaking ACHD. This study aimed to evaluate the reliability and validity of the German WHOQOL-BREF in this population. Methods: Descriptive statistics and item characteristics were calculated. Internal consistency was examined using Cronbach’s α and item-rest correlations. Construct validity was assessed with confirmatory factor analysis (CFA) of the original four-domain model. Known-groups validity was evaluated by comparing QoL scores across NYHA class, arrhythmia, and heart failure status. Associations between WHOQOL-BREF domains and the global items of quality of life and general health were examined using regression models. Results: A total of 846 ACHD patients participated (mean age = 33.08 ± 12.0 years, 45.3% female); after excluding cases with excessive missing responses, 805 remained for analysis. Internal consistency ranged from acceptable to good (Cronbach’s α = 0.69–0.84). CFA confirmed the four-factor structure with good model fit (CFI = 0.993, RMSEA = 0.036, SRMR = 0.045). Known-groups comparisons showed lower QoL scores in patients with higher symptom burden. Regression analyses demonstrated that psychological and physical domains were the strongest factors of global QoL and health, explaining up to 47.4% and 44.8% of the variance. Conclusion: The German WHOQOL-BREF demonstrates good psychometric properties in ACHD and provides a robust tool for multidimensional QoL assessment, though the social domain shows limitations.

Introduction: The majority of clinical studies investigating patients with heart failure and a reduced ejection fraction (HFrEF) exclusively included patients with symptomatic heart failure. There is a paucity of information concerning the clinical characteristics, progression to symptomatic heart failure, heart failure hospitalization rates and survival in patients with asymptomatic systolic left ventricular dysfunction (ASLVD). We address this knowledge gap by describing the baseline characteristics of participants in the prospective observational TransitionCHF study of patients with reduced left ventricular Function in New York Heart Association (NYHA) functional Class I and comparing them to those of other recent trials in HFrEF. Methods: In total, 1005 individuals with ASLVD NYHA I with an ejection fraction ≤ 40% were recruited. Patient characteristics were compared with other studies involving patients with symptomatic heart failure. Multivariable linear regression and Pearson coefficients were used to determine the association between quality of life, mental health, markers of organ function, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) plasma levels, and exercise performance. Results: The mean age of participants was 60 ± 14 years and 18% were women. The mean ejection fraction was 36% and the mean left ventricular end-diastolic diameter was 59 mm. When compared with studies involving patients with symptomatic heart failure, the age was ≈ 5 years younger and the frequency of comorbidities was lower. The Short Form Health Survey-36 physical functioning score was moderately correlated with the Maastricht Vital Exhaustion Questionnaire (MQ; r = −0.44 and weakly with 6-min walking distance (r = 0.32), peak VO2 at ergospirometry (r = 0.28), and Heart Focus Anxiety (HAF17; r = −0.34). NT-proBNP levels showed a weak association with peak VO2 (r = −0.29) and the 6-min walk distance (r = −0.21). Conclusions: Patients included in the TransitionCHF study are younger and suffer from fewer comorbidities as compared with symptomatic heart failure patients. Associations between NT-proBNP levels and markers of exercise performance were weak.