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Marital status and outcomes in chronic heart failure: Does it make a difference of being married, widow or widower?
Bihter Senturk1, Hakki Kaya2, Ahmet Celik3
1Department of Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
Insights
Widowed patients with chronic heart failure (CHFrEF) face a higher risk of heart failure-related hospitalization (HFrH). However, this increased risk is specifically linked to widows, not widowers, in the TREAT-HF registry.
Area of Science:
- Cardiology
- Public Health
- Social Determinants of Health
Background:
- Chronic heart failure with reduced ejection fraction (CHFrEF) affects a significant population, with socioeconomic factors like marital status potentially influencing patient outcomes.
- Understanding disparities in healthcare outcomes based on marital status is crucial for targeted interventions in heart failure management.
Purpose of the Study:
- To investigate the association between marital status, specifically widowed versus married, and clinical outcomes in patients with CHFrEF.
- To determine if there are differential risks for heart failure-related hospitalization (HFrH) and all-cause mortality (ACM) between widowed and married CHFrEF patients.
Main Methods:
- Analysis of data from the Turkish Research Team in HF (TREAT-HF) registry, a network focused on CHFrEF patients.
- Comparison of outcomes (HFrH and ACM) between widowed (n=124) and married (n=562) CHFrEF patients.
- Propensity score (PS) matching analysis to control for confounding variables and assess the independent effect of marital status.
Main Results:
- Widowed CHFrEF patients exhibited a higher risk of HFrH compared to married patients, both before and after PS matching (p=0.047 and p=0.039, respectively).
- All-cause mortality (ACM) rates were similar between widowed and married CHFrEF patients (p=0.054 and similar post-PS matching).
- A significant finding was that only widows, not widowers, showed an increased risk of HFrH (p=0.037 for widows vs. p=0.419 for widowers) despite similar baseline characteristics.
Conclusions:
- Propensity score matching confirmed that widowed status is associated with an increased risk of heart failure-related hospitalization in CHFrEF patients.
- The increased risk of HFrH appears to be specific to widows, with widowers not demonstrating a similar elevated risk.
- These findings highlight the importance of considering gender-specific social factors in the management and risk stratification of CHFrEF patients.
Objective:
We aimed to compare the outcomes of chronic heart failure (HF) patients with reduced ejection fraction (CHFrEF) in the Turkish Research Team in HF (TREAT-HF) registry according to marital status with a specific focus on being the widowed (widow/widower) versus the married.
Methods:
TREAT-HF is a network, enrolling CHFrEF with a follow up for HF-related hospitalization (HFrH) and all-cause mortality (ACM). In this cohort, the widowed patients were compared with patients who were married before and after propensity score (PS) matching analysis.
Results:
There were 723 cHFrEF patients with a complete dataset, including reported marital status at baseline for this analysis. Out of 723 patients with HF, 37 "never-married" and "divorced" patients were excluded from the analysis. Then, out of 686 remaining patients with HF, who had at least one reported marriage in the database, widowed patients with HF (n=124) were compared with married patients (n=562). The mean follow up period was 21±12 months up to 48 months. The widowed patients had a higher risk of HFrH (p=0.047), although ACM remained similar compared to married patients (p=0.054). After PS matching, HFrH remained more frequent among the widowed compared with the married (p=0.039) although ACM yielded similar rates. Of note, it was shown that being a widower (p=0.419) was not linked to increased risk of HFrH during follow up contrary to being a widow (p=0.037) despite similar age, ejection fraction, creatinine, NYHA functional class distribution and a similar rate of life-saving medications.
Conclusion:
PS matching analysis yielded that the widowed had increased the risk for HFrH. Of note, widowers did not seem to have an increased risk for HFrH, contrary to widows.
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