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The Association between Marital Status and Outcomes of Patients Hospitalized with Heart Failure

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Abstract

Background

Little is known about the association between marital status and long-term outcomes of patients hospitalized with heart failure (HF). We aimed to examine the association between marital status and early as well as long-term outcomes of patients hospitalized with HF.

Method

We analyzed data of 4089 patients hospitalized with HF and were enrolled in the multicenter national survey in Israel between March and April 2003 and were followed until December 2014. Patients were classified into married (N = 2462, 60%) and unmarried (N = 1627, 40%).

Results

Married patients were more likely to be males, younger, and more likely to have past myocardial infarction and previous revascularization. Also, they tended to have higher rates of diabetes mellitus (DM) and dyslipidemia, as well as smokers. Survival analysis showed that unmarried patients had higher mortality rates at 1 and 10 years (33% vs. 25%, at 1 year, 89% vs. 80% at 10 years, all p < 0.001). Consistently, multivariable analysis showed that unmarried patients had independently 44% and 35% higher risk of mortality at 1- and 10-year follow-up respectively (1-year HR = 1.44; 95%CI 1.14–1.81; p = 0.002, 10-year HR = 1.35; 95%CI 1.19–1.53; p ≤ 0.001). Other consistent predictors of mortality at both 1- and 10-year follow-up include age, renal failure, and advanced HF.

Conclusions

Being unmarried is independently associated with worse short- and long-term outcomes, particularly among women. Thus, attempts to intensify secondary preventive measures should focus mainly on unmarried patients and mainly women.

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References

  1. Komanduri S, Jadhao Y, Guduru SS, et al. Prevalence and risk factors of heart failure in the USA: NHANES 2013–2014 epidemiological follow-up study. J Community Hosp Intern Med Perspect. 2017;7:15–20.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Shah KS, Xu H, Matsouaka RA, et al. Heart failure with preserved, borderline, and reduced ejection fraction: 5-year outcomes. J Am Coll Cardiol. 2017;70:2476–86.

    Article  PubMed  Google Scholar 

  3. Virani SS, Alonso A, Benjamin EJ, et al. Heart Disease and Stroke Statistics-2020 update: a report From the American Heart Association. Circulation. 2020;141:e139–596.

    Article  PubMed  Google Scholar 

  4. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation. 2015;131:e29-322.

    PubMed  Google Scholar 

  5. McMurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993–1004.

    Article  PubMed  Google Scholar 

  6. Taylor CJ, Ordonez-Mena JM, Roalfe AK, et al. Trends in survival after a diagnosis of heart failure in the United Kingdom 2000–2017: population based cohort study. BMJ. 2019;364: l223.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Metra M, Teerlink JR. Heart failure. Lancet. 2017;390:1981–95.

    Article  PubMed  Google Scholar 

  8. Gustafsson F, Rogers JG. Left ventricular assist device therapy in advanced heart failure: patient selection and outcomes. Eur J Heart Fail. 2017;19:595–602.

    Article  PubMed  Google Scholar 

  9. Braunwald E. Heart failure. JACC. Heart Fail. 2013;1:1–20.

    Google Scholar 

  10. Maggioni AP, Dahlstrom U, Filippatos G, et al. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2013;15:808–17.

    Article  PubMed  Google Scholar 

  11. Dhindsa DS, Khambhati J, Schultz WM, et al. Marital status and outcomes in patients with cardiovascular disease. Trends Cardiovasc Med. 2020;30:215–20.

    Article  PubMed  Google Scholar 

  12. Schultz WM, Hayek SS, Samman Tahhan A et al. Marital status and outcomes in patients with cardiovascular disease. J Am Heart Assoc 2017;6.

  13. Wong CW, Kwok CS, Narain A, et al. Marital status and risk of cardiovascular diseases: a systematic review and meta-analysis. Heart. 2018;104:1937–48.

    Article  PubMed  Google Scholar 

  14. Marcus G, Litovchik I, Pereg D, et al. Impact of marital status on the outcome of acute coronary syndrome: results from the Acute Coronary Syndrome Israeli Survey. J Am Heart Assoc. 2019;8: e011664.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hayes RM, Carter PR, Gollop ND, et al. The impact of marital status on mortality and length of stay in patients admitted with acute coronary syndrome. Int J Cardiol. 2016;212:142–4.

    Article  PubMed  Google Scholar 

  16. Luttik ML, Jaarsma T, Veeger N, van Veldhuisen DJ. Marital status, quality of life, and clinical outcome in patients with heart failure. Heart Lung. 2006;35:3–8.

    Article  PubMed  Google Scholar 

  17. Rohrbaugh MJ, Shoham V, Coyne JC. Effect of marital quality on eight-year survival of patients with heart failure. Am J Cardiol. 2006;98:1069–72.

    Article  PubMed  Google Scholar 

  18. Chung ML, Lennie TA, Riegel B, et al. Marital status as an independent predictor of event-free survival of patients with heart failure. Am J Crit Care. 2009;18:562–70.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wu JR, Lennie TA, Chung ML, et al. Medication adherence mediates the relationship between marital status and cardiac event-free survival in patients with heart failure. Heart Lung. 2012;41:107–14.

    Article  PubMed  Google Scholar 

  20. Matsushita M, Shirakabe A, Hata N, et al. Social determinants are crucial factors in the long-term prognosis of severely decompensated acute heart failure in patients over 75 years of age. J Cardiol. 2018;72:140–8.

    Article  PubMed  Google Scholar 

  21. Hunt SA, College A, of C, American Heart Association Task Force on Practice G. ACC, AHA,. guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2005;2005(46):e1-82.

    Article  Google Scholar 

  22. Garty M, Shotan A, Gottlieb S, et al. The management, early and one year outcome in hospitalized patients with heart failure: a national Heart Failure Survey in Israel–HFSIS 2003. Isr Med Assoc J. 2007;9:227–33.

    PubMed  Google Scholar 

  23. Barsheshet A, Shotan A, Cohen E, et al. Predictors of long-term (4-year) mortality in elderly and young patients with acute heart failure. Eur J Heart Fail. 2010;12:833–40.

    Article  PubMed  Google Scholar 

  24. Younis A, Mulla W, Goldkorn R, et al. Differences in mortality of new-onset (de-novo) acute heart failure versus acute decompensated chronic heart failure. Am J Cardiol. 2019;124:554–9.

    Article  PubMed  Google Scholar 

  25. Mulla W, Goldenberg I, Klempfner R et al. Sex differences in clinical characteristics and 1- and 10-year mortality among patients hospitalized with acute heart failure. Am J Med Sci 2020.

  26. Mulla W, Klempfner R, Natanzon S et al. Female gender is associated with a worse prognosis amongst patients hospitalised for de-novo acute heart failure. Int J Clin Pract 2020: e13902.

  27. Rich MW, Gray DB, Beckham V, et al. Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure. Am J Med. 1996;101:270–6.

    Article  CAS  PubMed  Google Scholar 

  28. DiMatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol. 2004;23:207–18.

    Article  PubMed  Google Scholar 

  29. Molloy GJ, Hamer M, Randall G, Chida Y. Marital status and cardiac rehabilitation attendance: a meta-analysis. Eur J Cardiovasc Prev Rehabil. 2008;15:557–61.

    Article  PubMed  Google Scholar 

  30. Kulkarni SP, Alexander KP, Lytle B, et al. Long-term adherence with cardiovascular drug regimens. Am Heart J. 2006;151:185–91.

    Article  PubMed  Google Scholar 

  31. Shen BJ, Xu Y, Eisenberg S. Psychosocial and physiological predictors of mortality in patients of heart failure: independent effects of marital status and C-reactive protein. Int J Behav Med. 2017;24:83–91.

    Article  PubMed  Google Scholar 

  32. Burnett H, Earley A, Voors AA et al. Thirty years of evidence on the efficacy of drug treatments for chronic heart failure with reduced ejection fraction: a network meta-analysis. Circ Heart Fail 2017;10.

  33. Ergatoudes C, Schaufelberger M, Andersson B et al. Non-cardiac comorbidities and mortality in patients with heart failure with reduced vs. preserved ejection fraction: a study using the Swedish Heart Failure Registry. Clin Res Cardiol 2019;108:1025–33.

  34. Kewcharoen J, Thangjui S, Kanitsoraphan C, et al. The effects of marital status on outcome of heart failure population: a systematic review and meta-analysis. Acta Cardiol. 2021;76:11–9.

    Article  PubMed  Google Scholar 

  35. Lu MLR, Davila CD, Shah M, et al. Marital status and living condition as predictors of mortality and readmissions among African Americans with heart failure. Int J Cardiol. 2016;222:313–8.

    Article  PubMed  Google Scholar 

  36. Matthews KA, Gump BB. Chronic work stress and marital dissolution increase risk of posttrial mortality in men from the Multiple Risk Factor Intervention Trial. Arch Intern Med. 2002;162:309–15.

    Article  PubMed  Google Scholar 

  37. Orth-Gomer K, Wamala SP, Horsten M, et al. Marital stress worsens prognosis in women with coronary heart disease: The Stockholm Female Coronary Risk Study. JAMA. 2000;284:3008–14.

    Article  CAS  PubMed  Google Scholar 

  38. Beam CR, Dinescu D, Emery R, Turkheimer E. A twin study on perceived stress, depressive symptoms, and marriage. J Health Soc Behav. 2017;58:37–53.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Freudenberger R, Cahn SC, Skotzko C. Influence of age, gender, and race on depression in heart failure patients. J Am Coll Cardiol 2004;44: 2254–5; author reply 5–6.

  40. Gottlieb SS, Khatta M, Friedmann E, et al. The influence of age, gender, and race on the prevalence of depression in heart failure patients. J Am Coll Cardiol. 2004;43:1542–9.

    Article  PubMed  Google Scholar 

  41. Kristofferzon ML, Lofmark R, Carlsson M. Myocardial infarction: gender differences in coping and social support. J Adv Nurs. 2003;44:360–74.

    Article  PubMed  Google Scholar 

  42. Al-Khatib SM, Hellkamp AS, Hernandez AF, et al. Trends in use of implantable cardioverter-defibrillator therapy among patients hospitalized for heart failure: have the previously observed sex and racial disparities changed over time? Circulation. 2012;125:1094–101.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Pavlovic A, Polovina M, Ristic A, et al. Long-term mortality is increased in patients with undetected prediabetes and type-2 diabetes hospitalized for worsening heart failure and reduced ejection fraction. Eur J Prev Cardiol. 2019;26:72–82.

    Article  PubMed  Google Scholar 

  44. Damman K, Valente MA, Voors AA, et al. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J. 2014;35:455–69.

    Article  PubMed  Google Scholar 

  45. Murberg TA, Bru E, Aarsland T, Svebak S. Social support, social disability and their role as predictors of depression among patients with congestive heart failure. Scand J Soc Med. 1998;26:87–95.

    Article  CAS  PubMed  Google Scholar 

  46. Coyne JC, Rohrbaugh MJ, Shoham V, et al. Prognostic importance of marital quality for survival of congestive heart failure. Am J Cardiol. 2001;88:526–9.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The study was possible by the combined efforts of the HFSIS Study Group and the Israeli Association for Cardiovascular Trials.

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Authors and Affiliations

  1. The Sackler School of Medicine, The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel

    Leonid Maizels, Avishay Grupper, Arsalan Abu-Much, Sharon Natanzon, Aias Massalha, Israel Mazin & Anan Younis

  2. Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Beersheba, Israel

    Wesam Mulla

  3. Heart Center, Sheba Medical Center, Tel Hashomer, Sheba Road 2, 52620, Ramat Gan, Israel

    Anan Younis

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  1. Leonid Maizels
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  2. Wesam Mulla
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Correspondence to Anan Younis.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/ or national research committee and with 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Maizels, L., Mulla, W., Grupper, A. et al. The Association between Marital Status and Outcomes of Patients Hospitalized with Heart Failure. Int.J. Behav. Med. 30, 532–542 (2023). https://doi.org/10.1007/s12529-022-10117-2

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