Study: unmarried women are associated with a higher risk of death in patients with heart failure
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Study author Dr. Fabian kerwagen from the comprehensive heart failure center of the University Hospital of vilzburg, Germany, said: “Social support helps people manage their long-term illness. Spouses may assist in drug adherence, provide encouragement and help develop healthier behaviors, all of which may affect life expectancy. In this study, unmarried patients show less social interaction and lack confidence in managing their heart failure than married patients. We are exploring whether these factors can also partially explain the link with survival.”
Previous studies have shown that unmarried women predict a worse prognosis in the general population and patients with coronary artery disease. The post hoc analysis of the extended interdisciplinary network heart failure (e-inh) study investigated the predictive significance of marital status in patients with chronic heart failure.
The e-inh study consisted of 1022 patients hospitalized for decompensated heart failure between 2004 and 2007. Among the 1008 patients who provided marital status information, 633 (63%) were married, 375 (37%) were unmarried, including 195 widowed, 96 never married, and 84 separated or divorced.
At baseline, quality of life, social limitations, and self-efficacy were measured with the Kansas City Cardiomyopathy Questionnaire, a questionnaire specifically designed for patients with heart failure. Social restriction refers to the influence of heart failure symptoms on patients’ social communication ability, such as pursuing hobbies and recreational activities or visiting friends and family. Self efficacy describes a patient’s perception of their ability to prevent heart failure from worsening and manage complications. Depression was assessed with the patient health questionnaire (PHQ-9).
There was no difference between married and unmarried patients in terms of overall quality of life or depression. However, compared with the married group, the unmarried group scored lower in social restriction and self-efficacy.
During the 10-year follow-up, 679 patients (67%) died. Unmarried women had a higher risk of all-cause death (hazard ratio [hr] 1.58, 95% confidence interval [ci] 1.31-1.92) and cardiovascular death (HR 1.83, 95% CI 1.38-2.42) than married women. Widowed patients had the highest risk of death. Compared with the married group, the hazard ratios of all-cause death and cardiovascular death were 1.70 and 2.22, respectively.
Dr kerwagen said: “The link between marriage and longevity shows the importance of social support for patients with heart failure, a topic that has become more relevant with social alienation during the pandemic. Health professionals should consider asking patients about their marital status and broader social groups, and recommending heart failure support groups to fill the potential gap. Education is crucial, but medical institutions also need to improve patients’ confidence in their ability to care for themselves. We are developing a mobile health application that we hope will help patients with heart failure with daily condition management. “