 |
|
The Clinical Course of Palpitations in Medical Outpatients
Arthur J. Barsky, MD;
Paul D. Cleary, PhD;
Remy R. Coeytaux;
Jeremy N. Ruskin, MD
Arch Intern Med. 1995;155(16):1782-1788.
Abstract
| |
Objective
The aim of this study was to describe the longitudinal course of patients who were referred for ambulatory electrocardiographic monitoring because of palpitations.
Methods
A prospective, follow-up examination was conducted of patients who had been studied 6 months previously when referred for monitoring. The inception cohort consisted of 145 consecutive patients with palpitations and 70 asymptomatic, nonpatient volunteers. At follow-up, the patients completed the same research battery as at inception, consisting of structured interviews and self-report questionnaires. These assessed cardiac symptoms, medical care use, role impairment, somatization, hypochondriacal fears and beliefs, and psychiatric disorder.
Results
At 6 months' follow-up, 130 patients with palpitations (89.7% of the original cohort) and 69 nonpatients (98.6%) were reinterviewed. Eighty-four percent of the patients had recurrent palpitations during the 6-month follow-up period. At follow-up, patients with palpitations scored significantly higher than the comparison group on measures of cardiac symptoms and role impairment, and had made more physician visits in the preceding 6 months. They had a higher prevalence of panic disorder and more psychopathologic symptoms, somatized more, and were more hypochondriacal. Psychiatric symptoms and the tendency to amplify bodily sensation, measured at inception, were significant but modest predictors of subsequent palpitations. There was considerable confusion and misunderstanding among patients as to the findings of their ambulatory electrocardiogram and the presence or absence of panic disorder.
Conclusions
Patients with palpitations remain symptomatic and functionally impaired and have increased rates of physician visits in the 6 months following Holter monitoring. They also continue to have elevated rates of panic disorder and to evidence some confusion about the cause of their symptoms.
(Arch Intern Med. 1995;155:1782-1788)
Author Affiliations
From the Departments of Psychiatry (Dr Barsky) and Medicine (Dr Ruskin), and Department of Health Care Policy (Dr Cleary), Harvard Medical School; Division of Psychiatry, Brigham and Women's Hospital (Dr Barsky); and Psychiatry Service (Mr Coeytaux) and Medical Service (Dr Ruskin), Massachusetts General Hospital, Boston.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Does This Patient With Palpitations Have a Cardiac Arrhythmia?
Thavendiranathan et al.
JAMA 2009;302:2135-2143.
ABSTRACT
| FULL TEXT
Alexithymia Does Not Predict the Persistence of Medically Unexplained Physical Symptoms
Kooiman et al.
Psychosom. Med. 2004;66:224-232.
ABSTRACT
| FULL TEXT
Depression Predicts Revascularization Procedures for 5 Years After Coronary Angiography
Sullivan et al.
Psychosom. Med. 2003;65:229-236.
ABSTRACT
| FULL TEXT
Characteristics of patients presenting to a cardiac clinic with palpitation
Mayou et al.
QJM 2003;96:115-123.
ABSTRACT
| FULL TEXT
Palpitations, Arrhythmias, and Awareness of Cardiac Activity
Barsky
ANN INTERN MED 2001;134:832-837.
ABSTRACT
| FULL TEXT
Psychological and Perceptual Factors Associated With Arrhythmias and Benign Palpitations
Ehlers et al.
Psychosom. Med. 2000;62:693-702.
ABSTRACT
| FULL TEXT
Evaluation of Patients with Palpitations
Zimetbaum and Josephson
NEJM 1998;338:1369-1373.
FULL TEXT
Differential Diagnosis of Palpitations: Preliminary Development of a Screening Instrument
Barsky et al.
Arch Fam Med 1997;6:241-245.
ABSTRACT
Somatized Psychiatric Disorder Presenting as Palpitations
Barsky et al.
Arch Intern Med 1996;156:1102-1108.
ABSTRACT
Palpitations in Outpatients
JWatch Psychiatry 1995;1995:19-19.
FULL TEXT
PALPITATIONS IN OUTPATIENTS
JWatch General 1995;1995:6-6.
FULL TEXT
|
