Being unmarried is associated with a higher risk of death in heart failure patients

Being unmarried is associated with a higher risk of death in heart failure patients

Unmarried heart failure patients appear less confident in managing their condition and more socially limited compared to their married counterparts, according to research presented today at Heart Failure 2022, a scientific congress of the European Society of Cardiology (ESC). These differences may have contributed to the worse long-term survival observed in unmarried patients.


Social support helps people managing long-term conditions,” said study author Dr. Fabian Kerwagen of the Comprehensive Heart Failure Center at the University Hospital Würzburg, Germany. “Spouses may assist with drug adherence, provide encouragement and help with developing healthier behaviours, all of which could affect longevity. In this study, unmarried patients exhibited fewer social interactions than married patients, and lacked confidence to manage their heart failure. We are exploring, whether these factors could also partially explain the link with survival.”


The prognostic relevance of marital status in patients with chronic heart failure


Previous studies have shown that being unmarried is an indicator of a less favourable 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 investigated the prognostic relevance of marital status in patients with chronic heart failure.

The E-INH study included 1,022 patients hospitalised between 2004 and 2007 for decompensated heart failure. Out of 1,008 patients providing information on marital status, 633 (63%) were married and 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 using the Kansas City Cardiomyopathy Questionnaire, a questionnaire specifically designed for patients with heart failure. Social limitation refers to the extent to which heart failure symptoms affect patients’ ability to interact socially, such as pursuing hobbies and recreational activities, or visiting friends and family. Self-efficacy describes patients’ perception of their ability to prevent heart failure exacerbations and manage complications. Depressed mood was assessed using the Patient Health Questionnaire (PHQ-9).


Worse on social limitations and self-efficacy


There were no differences between married and unmarried patients regarding overall quality of life or depressed mood. However, the unmarried group scored worse on social limitations and self-efficacy compared with the married group.


During 10 years of follow-up, 679 (67%) patients died. Being unmarried versus married was associated with higher risks for 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). Widowed patients carried the highest mortality risk, with hazard ratios of 1.70 and 2.22 for all-cause and cardiovascular death, respectively, compared to the married group.

The connection between marriage and longevity indicates the importance of social support for patients with heart failure, a topic which has become even more relevant with social distancing during the pandemic. Health professionals should consider asking patients about their marital status and wider social group and recommending heart failure support groups to fill potential gaps. Education is crucial but health providers also need to boost patients’ confidence in their self-care abilities. We are working on a mobile health application which we hope will assist heart failure patients in the day-to-day management of their condition”, Dr. Kerwagen said.