Work-related stress caused by workload and an imbalance between effort and reward received may increase the risk of atrial fibrillation, according to a new study published in Journal of the American Heart Association.

Atrial fibrillation, also known as AFib or AF, is the most common form of arrhythmia – an abnormal heart rhythm. It can lead to stroke, heart failure, or other cardiovascular complications. According to the American Heart Association’s heart disease and stroke statistics for 2024, more than 12 million people in the United States are expected to have AFib by 2030.

Previous research has linked high workloads and effort-reward imbalances in the workplace to an increased risk of coronary heart disease. This research is the first to examine the negative impact of both psychosocial workplace stressors on atrial fibrillation, said study lead author Xavier Trudel, Ph.D., an occupational and cardiovascular epidemiologist and associate professor at Laval University in Quebec City, Quebec, Canada.

“Our study suggests that work-related stressors may be relevant factors that should be included in prevention strategies,” Trudel said. “Recognizing and addressing psychosocial stressors in the workplace is necessary to promote a healthy work environment that benefits both individuals and the organizations in which they work.”

Trudel and his team studied the effects of job strain, which is defined as a work environment in which employees face high demands such as heavy workloads and tight deadlines, and have little control over their work and say in decisions and the execution of their tasks.

Another factor examined in the study was effort-reward imbalance, which occurs when employees put a lot of effort into their work but feel that the rewards they receive—such as salary, recognition, or job security—are inadequate or not commensurate with their performance.

Researchers examined the medical records of nearly 6,000 adults in white-collar jobs in Canada and built 18 years of follow-up data. The analysis found:

• Employees who reported being exposed to high levels of occupational stress had an 83% higher risk of developing atrial fibrillation than employees who were not exposed to these stressors.
• Among those who perceived an imbalance between effort and reward, the risk was 44% higher than among employees who did not report this imbalance.
• The combined perception of high workload and effort-reward imbalance was associated with a 97% increased risk of atrial fibrillation.

“The effectiveness of workplace interventions to reduce psychosocial stressors that may also reduce the risk of atrial fibrillation should be investigated in future research,” Trudel said. “Our research team previously implemented an organizational intervention to reduce psychosocial stressors in the workplace that was shown to effectively reduce blood pressure. Examples of organizational changes implemented during the intervention included slowing down the implementation of a large project to prevent increased workload, introducing flexible working hours, and holding meetings between managers and employees to discuss daily challenges.”

Limitations of the study include that participants were exclusively white-collar workers, including managers, professionals, and office workers in Canada, meaning the results may not apply to other types of workers or to workers in other countries.

Study details and design:

• The researchers collected data as part of the PROspective Quebec (PROQ) study on work and health, which began in the Quebec region from 1991 to 1993 and recruited employees from 19 public and parapublic organizations.
• A total of 5,926 workers (49% men, 51% women) were included in this analysis. Their average age was 45 years at the start of the study (1999–2001) and 65 years at the end of follow-up (December 2018). Most study participants were white adults.
• Work stress was assessed using self-report questionnaires.
• The analysis identified 186 cases of atrial fibrillation. In this group, 19% of those affected reported high workloads, 25% said they perceived an imbalance between effort and reward, and 10% reported experiencing both stressors simultaneously.
• More than a third of the participants had been diagnosed with coronary heart disease or heart failure before the onset of atrial fibrillation.
• The study measured work-related stressors using self-report questionnaires, particularly on workload and effort-reward imbalance, while taking into account a broad list of socioeconomic characteristics (gender and education), health risks (diabetes status and hypertension), and lifestyle factors (smoking and alcohol).