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September 11, 1995

The Clinical Course of Palpitations in Medical Outpatients

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.

Arch Intern Med. 1995;155(16):1782-1788. doi:10.1001/archinte.1995.00430160124012

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)