Arrhythmia Risk During the 2016 US Presidential Election: The Cost of Stressful Politics

Abstract

Background Anger and extreme stress can trigger potentially fatal cardiovascular events in susceptible people. Political elections, such as the 2016 US presidential election, are significant stressors. Whether they can trigger cardiac arrhythmias is unknown. Methods and Results In this retrospective case‐crossover study, we linked cardiac device data, electronic health records, and historic voter registration records from 2436 patients with implanted cardiac devices. The incidence of arrhythmias during the election was compared with a control period with Poisson regression. We also tested for effect modification by demographics, comorbidities, political affiliation, and whether an individual's political affiliation was concordant with county‐level election results. Overall, 2592 arrhythmic events occurred in 655 patients during the hazard period compared with 1533 events in 472 patients during the control period. There was a significant increase in the incidence of composite outcomes for any arrhythmia (incidence rate ratio [IRR], 1.77 [95% CI, 1.42–2.21]), supraventricular arrhythmia (IRR, 1.82 [95% CI, 1.36–2.43]), and ventricular arrhythmia (IRR, 1.60 [95% CI, 1.22–2.10]) during the election relative to the control period. There was also an increase in specific types of arrhythmia, including atrial fibrillation (IRR, 1.50 [95% CI, 1.06–2.11]), supraventricular tachycardia (IRR, 3.7 [95% CI, 2.2–6.2]), nonsustained ventricular tachycardia (IRR, 1.7 [95% CI, 1.3–2.2]), and daily atrial fibrillation burden ( P <0.001). No significant interaction was found for sex, race/ethnicity, device type, age ≥65 years, hypertension, coronary artery disease, heart failure, political affiliation, or concordance between individual political affiliation and county‐level election results. Conclusions There was a significant increase in cardiac arrhythmias during the 2016 US presidential election. These findings suggest that exposure to stressful sociopolitical events may trigger arrhythmogenesis in susceptible people.

Association of the 2020 US Presidential Election With Hospitalizations for Acute Cardiovascular Conditions

“…Results from this study are consistent with other studies surrounding the 2016 election. 6 , 7 Rosman and colleagues 7 studied patients in 2 health care centers in North Carolina, and they found a 77% higher risk of cardiac arrhythmia in the 6 weeks after the 2016 election compared with a similar period before the election. Results were consistent by age group, sex, and race and ethnicity, and the authors also reported no differences by political affiliation or political concordance or discordance—although they note small sample sizes as the potential limitation to some of these findings.…”

“… 6 Other studies have similarly presented evidence of cardiovascular and noncardiovascular adverse outcomes associated with political stress and, more specifically, the 2016 presidential election. 7 , 8 , 9 The aim of the current study was to replicate and expand on findings from our prior study of the 2016 presidential election that was limited to the Southern California population by examining hospitalizations for acute CVD around the 2020 presidential election among adults in KPSC and Kaiser Permanente Northern California (KPNC), 2 large integrated health care delivery systems that provide comprehensive care for more than 9 million persons.…”

Racial and ethnic differences in blood pressure before and after the 2016 United States general election

“…In previous studies, major sociopolitical events were associated with significant changes in self‐rated health status, mental health, and cortisol levels (Brown et al, 2021; Hoyt et al, 2018; Malat et al, 2011). Recent data also suggests that incidence of cardiac arrythmias and CVD hospitalizations increased during the 2016 presidential election (Mefford et al, 2020; Rosman et al, 2021); however, the underlying mechanisms driving these increases, including potentially stress‐related increases in BP, remain unknown. Our findings suggest that population‐level BP, particularly among racial/ethnic minorities, may have increased following the election.…”

Resentment Is Like Drinking Poison? The Heterogeneous Health Effects of Affective Polarization

“…Mefford et al (2020), for example, document an increase in acute cardiovascular disease hospitalizations in California immediately after the 2016 election. Similarly, Rosman et al (2021) show that North Carolina patients with cardiac devices were more likely to experience arrhythmic events during the election. Consistent with the literature examining minority group health, the focus of research documenting these general health effects for the 2016 election suggests a shared sentiment among scholars that many Americans perceived it to be of particularly high stakes and therefore a more stressful, health-threatening experience.…”