Psychological and Autonomic Outcomes Following a Multimodal Intervention in Arrhythmia Patients: A Longitudinal Cohort Study Before and After the COVID-19 Pandemic

Abstract

Background: The COVID-19 pandemic triggered a global mental health crisis, exacerbating stress, anxiety, and autonomic dysfunction. Behavioral lifestyle interventions are established for arrhythmia management, but their comparative efficacy before versus after a population-wide psychological stressor remains unexplored.
Objective: This study compared 4-year clinical and psychological outcomes of the proven standardized multimodal behavioral intervention Group 7 (G_7) protocol (combining Shiatsu, structured exercise, stress management, and lifestyle counseling) in patients with arrhythmias treated before (2016–2019) and after (2021–2024) the COVID-19 pandemic. The study aimed to clarify potential temporal and demographic confounding between cohorts, establish precise outcome definitions, and compare longitudinal treatment trajectories.
Methods: A retrospective longitudinal cohort analysis was conducted on 780 patients treated with the identical intervention protocol, grouped into Pre-Pandemic (2016–2019, n=390) and Post-Pandemic (2021–2024, n=390) cohorts. A detailed sub-sample of 195 patients (randomized into 13 groups of n=15 each) underwent additional prospective assessment of arrhythmia burden, hemodynamics, and psychological scores (Perceived Stress Scale-10 [PSS-10], Kessler Psychological Distress Scale [K10]) to validate and extend the primary findings. Primary outcomes were changes in Heart Rate Variability (SDNN) and arrhythmia burden (defined as total PVC/PAC counts per 24–48h Holter) and HRV outcomes (SDNN in ms). Between-cohort changes and interaction effects were evaluated using linear mixed-effects models adjusting for baseline age, sex, healthcare access, and baseline distress.
Results: Both cohorts showed significant improvements following the multimodal behavioral intervention, with the post-pandemic cohort demonstrating enhanced efficacy, particularly in psychological and autonomic metrics, compared to the pre-pandemic average. Intervention adherence remained extremely high across both eras (overall completion >98%).
Conclusions: These findings from a large longitudinal cohort (n=780) and a detailed sub-sample (n=195) suggest that individuals with higher baseline psychological distress may derive particular benefit from autonomic and psychological resilience-building interventions. Prospective, controlled studies are warranted to confirm this effect and to identify behavioral mechanisms of enhanced responsiveness.