Single patients with heart failure seem less confident in managing 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 worse long-term survival observed in single patients.
“Social support helps people managing long-term conditions,” said study author Dr. Fabian Kerwagen, from the Comprehensive Heart Failure Center at University Hospital Würzburg, Germany. “Spouses can help with medication adherence, provide encouragement, and help develop healthier behaviors, all of which can affect 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 may also partly explain the link with survival,” he added.
Previous studies have shown that being single is an indicator of a less favorable 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 examined the prognostic relevance of vital statistics in patients with chronic heart failure.
The E-INH study studied 1,022 patients hospitalized between 2004 and 2007 for decompensated heart failure. Of the 1,008 patients who provided marital status information, 633 (63%) were married and 375 (37%) were unmarried, including 195 widowed, 96 never married, and 84 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 symptoms of heart failure affect 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 regarding overall quality of life or depressed mood. However, the single group performed worse on social limitations and self-efficacy than the married group.
During the 10 years of 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 mortality risk, with hazard ratios of 1.70 and 2.22 for all-cause death 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, a topic that has become even more relevant with social distancing during the pandemic. Healthcare professionals should consider asking patients regarding their marital status and broader social group, and recommending support groups for people with heart failure to fill any gaps. Education is crucial, but healthcare providers also need to build patients’ confidence in their self-care abilities. We are currently working on a mobile health app which we hope will help heart failure patients manage their disease on a day-to-day basis. »
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