PREDICTORS OF PERSISTENT PALPITATIONS AND CONTINUED MEDICAL UTILIZATION

Background. The aim of this study was to determine the predictors of p ersistent palpitations and continued medical utilization in a sample o f medical patients referred for ambulatory electrocardiographic monito ring. Methods. A prospective telephone follow-up was conducted with pa tients who had undergone ambulatory electrocardiographic monitoring 3 months earlier. At inception, patients completed in-person interviews and self-report questionnaires, assessing somatization, hypochondriaca l attitudes, bodily amplification (high degree of sensitivity to bodil y sensations), and two types of life stress (minor daily irritants and major life changes). At Follow-up, patients completed a structured in terview about their clinical course, palpitations, and utilization of medical care during the interval. Results. At 3-month follow-up, 55 of the inception cohort of 67 patients were interviewed again. The mean severity of palpitations for the entire sample declined significantly, but 46 (83.6%) patients continued to experience their presenting symp toms. Stepwise multiple linear regression revealed that the interactio n of bodily amplification and daily life stress at inception uniquely explained 10.0% of the variance in palpitation severity at follow-up. A four-step model composed of these two interaction terms and age and education level accounted for 21.4% of the variance in palpitations. T he medical utilization findings are complementary in that the interact ion of amplification and daily irritants at baseline predicted the num ber of unscheduled medical visits over the subsequent 3 months. The to tal number of ventricular premature contractions occurring during ambu latory monitoring was nor a significant predictor of palpitations. Con clusions. Palpitations are more persistent in persons who are both hig hly sensitive to bodily sensations and who experience a greater number of minor daily irritants. The existence of either predictor alone is not sufficient to perpetrate this functional somatic symptom; it requi res the combination of these predictors.