According to new research by the scientific congress of the European Society of Cardiology, unmarried heart failure patients appear less confident in managing their condition and more socially limited than their married counterparts (ESC). These distinctions may have contributed to unmarried patients' poorer long-term survival.
"Social support helps people manage long-term conditions," said study author Dr Fabian Kerwagen of the Comprehensive Heart Failure Center at the University Hospital Wurzburg, 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 the confidence to manage their heart failure. We are exploring, whether these factors could also partially explain the link with survival."
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 posthoc 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 per cent) were married and 375 (37 per cent) 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).
There were no differences between married and unmarried patients regarding the 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 per cent) patients died. Being unmarried versus married was associated with higher risks for all-cause death (hazard ratio [HR] 1.58, 95 per cent confidence interval [CI] 1.31-1.92) and cardiovascular death (HR 1.83, 95 per cent 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.
Dr Kerwagen said: "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."
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