Cardiac Arrhythmias Rose During the 2016 Presidential Election

Atrial Fibrillation, Arrhythmia, human heart
Atrial Fibrillation, Arrhythmia, human heart
Researchers sought to determine whether the stress of a contentious political election increases the risk of arrhythmia in patients with known susceptibility.

The 2016 presidential election was associated with a greater risk for supraventricular and ventricular arrhythmias, according to a study recently published in the Journal of the American Heart Association.

This retrospective case-crossover study included 2436 individuals, of whom 53.2% (n=1236) had an implanted cardiac device and 46.8% (n=1140) had a pacemaker. The mean age of the study population was 70.8±12.9 years. They were predominantly White (74.5%); were mostly men (59.4%); and had hypertension (62.6%), congestive heart failure (50.8%), and atrial fibrillation or atrial flutter (46.9%), among other cardiovascular diseases.

A Poisson regression was used to compare the incidence of arrhythmia during the 2016 election (2 weeks before and 4 weeks after Election Day) with a 6-week control period (June 1, 2016, to July 12, 2016). Demographic characteristics, political affiliation, comorbidities, and whether a person’s political favorings matched the election results of their county were assessed for potential effect modification.

During the election period, 655 individuals in the study population experienced 2592 arrhythmia events, compared with 472 individuals experiencing 1533 events during the control period; the incidence rate ratio (IRR) of events during the election vs control period was 1.77 (95% CI, 1.42-2.21). Atrial fibrillation was 1.5 times (95% CI, 1.06-2.11) more likely, supraventricular tachycardia 3.7 times (95% CI, 2.2-6.2) more likely, and nonsustained ventricular tachycardia 1.7 times (95% CI, 1.3-2.2) more likely (P <.001).

The administration of anti-tachycardia pacing therapies was 11.6 times (95% CI, 3.2-42.0) more likely during the election period. Composite outcome analysis produced similar results: a higher risk for supraventricular arrhythmia (IRR, 1.82; 95% CI, 1.36-2.43) and for ventricular arrhythmia (IRR, 1.60; 95% CI, 1.22-2.10).

The interactions of race and ethnicity, sex, type of device, aged 65 years and older, coronary artery disease, hypertension, political affiliation, heart failure, and alignment between political affiliation and county election results were all insignificant.

Limitations of these findings include a lack of causal inference, a lack of information on time-varying confounders, the use of validated device detection algorithms that may have misclassified certain cardiac events, the influence of the length of assessment period on the results, and the use of voter registration cards to ascertain voting behaviors.

The study researchers concluded that “exposure to a stressful political election was associated with an increased risk [for] both supraventricular and ventricular arrhythmias,” as well as “a higher burden of [atrial fibrillation] in people with underlying cardiovascular disease.”

Disclosures: Some authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Rosman L, Salmoirago-Blotcher E, Mahmood R, et al. Arrhythmia risk during the 2016 US presidential election: the cost of stressful politics. J Am Heart Assoc. Published online May 20, 2021. doi:10.1161/JAHA.120.020559