Those who are single have a higher risk of dying from heart failure

Single heart failure patients appear to be less confident in dealing with their disease and more socially restricted than married people, according to a new study from the European Society of Cardiology.

These differences would have contributed to the poorer long-term survival observed in individual patients.

“Social support helps people cope with long-term illness,” said study author Dr. Fabian Kerwagen from the Comprehensive Heart Failure Center at the University Hospital of Würzburg, Germany. “Spouses can help with medication adherence, provide encouragement, and help develop healthier behaviors, all of which can impact longevity. In this study, unmarried patients had fewer social interactions than married patients and lacked the confidence to manage their heart failure. We are investigating whether these factors can also partially explain the association with survival,” he added.

Previous studies have shown that being alone is an indicator of a poorer prognosis, both in the general population and in patients with coronary artery disease. This post hoc analysis of the Extended Interdisciplinary Network Heart Failure (E-INH) study evaluated the prognostic relevance of vital statistics in patients with chronic heart failure.

The E-INH study evaluated 1,022 patients hospitalized for congestive heart failure between 2004 and 2007. Of the 1,008 patients who reported marital status, 633 (63%) were married and 375 (37%) were unmarried, of which 195 were widowed, 96 were unmarried, and 84 were separated or divorced.

Initially, quality of life, social limitations, and self-efficacy were measured using the Kansas City Cardiomyopathy Questionnaire, a questionnaire specifically designed for patients with heart failure. Social limitations refer to the extent to which heart failure symptoms interfere with patients’ ability to interact socially, such as pursuing hobbies and recreational activities or visiting friends and family. Self-efficacy describes patients’ perceptions of their ability to prevent heart failure exacerbations and manage complications. Depressed mood was assessed using the Patient Health Questionnaire (PHQ-9).

No differences were found between married and unmarried patients in terms of general quality of life or depressed mood. However, the single group performed worse than the married group on social limitations and self-efficacy.

During the 10-year follow-up, 679 (67%) patients died. Being single or married was associated with a higher risk of death from all causes (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). Widowed patients had the highest risk of mortality, with hazard ratios of 1.70 and 2.22 for all-cause and cardiovascular death, respectively, compared to the married patient group.

dr Kerwagen said: “The link between marriage and longevity points to the importance of social support for heart failure patients, an issue that has become even more relevant with social distancing during the pandemic. Healthcare professionals should consider asking patients about their marital status and broader social group, and recommending heart failure support groups to fill any gaps. Education is crucial, but healthcare providers also need to build patients’ confidence in their ability to take care of themselves. We are currently working on a mobile health app that we hope will help heart failure patients to manage their disease on a daily basis. »

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