'Vital exhaustion' study links burnout to a deadly consequence

Stressful life events, whether it’s an overwhelming job or caring for an ailing parent, can sap the life out of you. The experience of persistent stress can turn into burnout, also known as vital exhaustion, which can eventually induce intense fatigue, irritability, and demoralization.

Vital exhaustion is more than a bad night’s sleep or snapping in a meeting — it’s a “growing epidemic” and chronic condition that has a potentially deadly cost, a new study on 11,445 individuals suggests.

Researchers reported Monday in the European Journal of Preventive Cardiology that vital exhaustion can heighten the risk of developing atrial fibrillation (Afib) by up to 20 percent. People with Afib have an irregular heart rate. This can increase their risk of having a stroke, heart attack, or dying prematurely.

Co-author Parveen Garg, a researcher at the University of Southern California Medical School, tells Inverse that this new research illuminates how burnout can manifest in tangible, physiological ways.

“We usually just connect exhaustion with mental health,” Garg says. “If you’re exhausted or burned out, you can develop depression or you can become socially isolated. But I think this paper, and our other research, demonstrates that exhaustion can affect the health of your heart as well.”

Why is burn out so common?

While burnout is sometimes cast off as a “millennial problem,”, Garg asserts the phenomenon is something worth taking seriously. Feeling burned out is not something that’s felt one day and then gone the next, the cardiologist emphasizes.

Garg explains that’s there’s a difference between vital exhaustion and more typical exhaustion. Vital exhaustion, Garg says, is the experience of “profound stress” that’s goes “unchecked, unmanaged, or is unrelenting over time.” It’s not a transient feeling of fatigue — it sticks with you and can lead to decreased motivation and increased irritability.

"The problem is, it’s not something we recognize until it’s too late.”

Studies suggest that vital exhaustion diminishes people’s quality of life and, in turn, translates to measurable negative health outcomes. But unfortunately, it isn’t an easy condition to identify.

“The problem is, it’s not something we recognize until it’s too late,” Garg says.

This is compounded because people often live in environments where feeling undervalued, overwhelmed, or highly-stressed becomes normalized.

“These things are almost insidious in a way — it is not like you understand that it is going on at the moment,” Garg says. “Then finally, sometime later, you get these feelings of exhaustion or burnout and it’s hard to recognize what caused it.”

There’s no clear timeline of when stress turns into vital exhaustion — and the transition can be driven by small stressors accumulating over time. Garg explains that a combination of how severe the underlying stressor is and how long it persists leads to the burnout.

What is Afib?

The heart doesn’t always beat like a metronome. Sometimes, cardiac rhythms get out of whack, and when a heartbeat starts to quiver, speed up, or flutter over time, it could be signaling a common, but potentially dangerous heart condition called atrial fibrillation (Afib). Afib can cause blood clots and increase people’s risk of stroke, heart failure, and death.

People with Afib don’t always know it, Garg says. Some symptoms of the heart condition include shortness of breath and weakness.

Garg’s new research suggests this heart irregularity and vital exhaustion are linked. Burnout can threaten otherwise healthy people’s cardiac function, damaging heart tissue and making their hearts misfire.

To make this connection, Garg and his team explored how a variety of factors, including anger, antidepressant use, and social support, influence the development of atrial fibrillation in a group of 11,445 participants involved in the Atherosclerosis Risk in Communities Study.

Using data dating back to 1990, the team tracked cardiac health outcomes and periodically gathered data on participants’ psychological and social lives. Participants in the study filled out a survey that measured symptoms like crying spells, productivity, and sleep patterns. This information was used to create a “vital exhaustion score” designed to capture their level of burnout.

At the start of the study period, researchers also asked participants to bring in their medications, including supplements and antidepressants. Furthermore, scientists analyzed the strength of the participants’ social ties and their anger levels.

Over the course of 25 years, the team documented a total of 2,220 Afib cases and compared those cases to their corresponding hospital records and electrocardiogram scans. These capture the electrical activity of the heart.

Combining the cardiac and lifestyle data, the researchers found vital exhaustion was associated with increased risk of developing Afib, while no significant association was found between anger, social ties, or antidepressant use and developing the irregularity. Participants with a vital exhaustion score in the fourth quartile — those who reported the most burnout symptoms — had a 20 percent higher risk of developing Afib compared to only those in the first quartile, or those reporting zero or low symptoms of vital exhaustion.

Previous research linked antidepressant use and increased risk of Afib, so this finding was relatively surprising, Garg tells Inverse. 

However, he notes that the total body research still suggests a connection between antidepressants and Afib, and more research is needed to parse the relationship.

Garg isn’t sure exactly how vital exhaustion may damage heart tissue over time but speculates two mechanisms underpin the effect: inflammation and high levels of stress hormones.

Exhaustion alters the body’s stress response and recovery, while increasing inflammation. High levels of stress hormones — like epinephrine and norepinephrine — paired with increased markers of inflammation, can damage heart tissue over time and may prevent the electrical impulses in the heart from traveling and conducting normally.

Managing burnout

Vital exhaustion often leads people to abandon healthy habits like regular exercise or a nutrient-rich diet, practices that strengthen the heart. But vital exhaustion isn’t inevitable and burnout can be managed and prevented.

Garg explains that these preventative steps range from making sure you go outside and get some sun, to practicing yoga, to “just talking to a friend about what’s going on or talking to a professional.”

At this stage, Garg’s study doesn’t have clinically actionable implications for the way doctors treat or counsel patients at risk of Afib. Still, the findings are novel, and will likely lead to other studies examining whether vital exhaustion actually causes Afib, or if other factors are at play. Further research will reveal whether burnout prevention will become an approach cardiologists take to help patients.

“The focus is really on trying to be more aware, and improving our understanding of how these small things that seem small on a day-to-day basis can actually lead to pretty profound effects later on,” Garg says.

Abstract:

Background: We examined the relationships of anger, vital exhaustion, anti-depressant use, and poor social ties with incident atrial fibrillation in a biracial cohort of middle and older-aged adults.

Methods: This analysis included 11,445 Atherosclerosis Risk in Communities Study participants who were free of atrial fibrillation at baseline in 1990–1992. Vital exhaustion was assessed at baseline and defined as a score in the highest quartile on the 21-item Vital Exhaustion Questionnaire. Baseline anti-depressant use was self-reported. The Spielberger Trait Anger Scale to assess anger and both the Interpersonal Support Evaluation List and the Lubben Social Network Scale to assess social ties were also administered at baseline. The primary outcome was incident atrial fibrillation throughout 2016, identified by electrocardiogram, hospital discharge coding of atrial fibrillation, and death certificates. >Results: A total of 2220 incident atrial fibrillation cases were detected over a median follow-up of 23.4 years. After adjusting for age, race-center, sex, education, and height, participants in the 4th Vital Exhaustion Questionnaire quartile (referent 1⁄4 1st Vital Exhaustion Questionnaire quartile) and those reporting anti-depressant use were at increased risk for atrial fibrillation (hazard ratio 1⁄4 1.45, 95% confidence interval 1.29–1.64 for Vital Exhaustion Questionnaire; hazard ratio 1⁄4 1.37, 95% confidence interval 1.11–1.69 for anti-depressant use). The increased atrial fibrillation risk observed for 4th Vital Exhaustion Questionnaire quartile participants remained significant after additional adjustment for relevant comorbidities (hazard ratio 1⁄4 1.20; confidence interval 1.06–1.35). No significant associations were observed for anger or poor social ties with development of atrial fibrillation.

Conclusions: Vital exhaustion is associated with an increased risk of incident atrial fibrillation.