Prognostic importance of marital quality for survival of congestive heart failure
J C Coyne1, M J Rohrbaugh, V Shoham
1Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-4283, USA. jcoyne@mail.med.upenn.edu
Insights
Marital quality significantly impacts survival for patients with congestive heart failure (CHF). Good marital functioning improves prognosis, independent of illness severity, particularly for women.
Area of Science:
- Cardiology
- Psychosocial Medicine
- Clinical Research
Background:
- Social support is linked to better cardiovascular disease outcomes and reduced mortality.
- The specific impact of marital functioning on congestive heart failure (CHF) prognosis is not well understood.
Purpose of the Study:
- To investigate the prognostic significance of marital quality for patient survival in congestive heart failure (CHF).
- To compare the predictive power of marital quality with illness severity (New York Heart Association [NYHA] class).
Main Methods:
- 189 patients with CHF and their spouses were assessed using interview and observational measures of marital quality.
- Patient survival was tracked for up to 48 months.
- Cox regression analyses were used to evaluate predictors of mortality.
Main Results:
- Four-year survival rates were 52.5% for men and 68% for women.
- Marital quality independently predicted 4-year survival, comparable to NYHA class (p <0.001).
- The prognostic value of marital quality was stronger for female patients and remained significant after adjusting for CHF severity.
Conclusions:
- Marital quality is a significant independent predictor of mortality in patients with congestive heart failure (CHF).
- Both marital quality and NYHA class contribute independently to predicting patient survival.
- These findings highlight the importance of considering psychosocial factors, like marital functioning, in managing CHF.
Abstract:
Mounting evidence indicates that social support is associated with better outcomes of cardiovascular disease and reduced all-cause mortality. Much less is known about the specific contribution of marital functioning to these outcomes, and the potential prognostic significance of marital quality for congestive heart failure (CHF) has not been explored. Interview and observational measures of marital quality obtained from 189 patients with CHF (139 men and 50 women) and their spouses were examined as predictors of patient survival up to 48 months after assessment and compared with prediction based on illness severity (New York Heart Association [NYHA] class). Four-year survival rates were 52.5% and 68% for male patients and female patients, respectively. In Cox regression analyses, a composite measure of marital quality predicted 4-year survival as well as the patient's concurrent NYHA class did (both p <0.001). Adjusting for CHF severity did not diminish the prognostic significance of marital functioning, and prediction of survival from marital quality appeared stronger for female than for male patients. Thus, when marital quality and NYHA class are considered jointly, they both make independent, statistically significant contributions to the prediction of patient mortality.
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