Heart failureEffect of Marital Quality on Eight-Year Survival of Patients With Heart Failure
Section snippets
Participants
Patients and spouses were recruited from admissions to University of Michigan Medical Center HF clinics from 1993 to 1995. Inclusion required a HF diagnosis and documentation during the past year of a left ventricular ejection fraction <35%. Of the 258 couples contacted, 201 (78%) enrolled in the study, with the 2 partners completing consent forms. The survival analyses did not include 10 patients who later underwent heart transplantation and 2 couples who provided insufficient marital data.
The
HF severity, demographics, and patient survival
As expected, NYHA class was a strong predictor of patient survival during the 8-year follow-up period. The gender-adjusted relative risk ratios (RRs) for survival in the Cox regression analyses were 0.57 per unit of NYHA (Wald 14.70, 95% confidence interval [CI] 0.42 to 0.75, p <0.001) and 0.75 for NYHA class I/II versus III/IV (Wald 6.02, 95% CI 0.60 to 0.94). There was also a significant gender effect in the direction of longer survival in women (Wald 4.64, p = 0.31) but no gender and NYHA
Discussion
These results confirm the prognostic importance of marital quality for longer term survival of patients with HF. The statistical effects of composite marital quality on all-cause mortality in our sample were independent of baseline illness severity and substantially more potent than those of individual (patient-level) risk and protective factors emphasized in the broader behavioral cardiology literature. Social relationship factors may be especially crucial to managing a difficult chronic
Acknowledgment
We are grateful to James A. Cranford, PhD, John M. Nicklas, MD, and John S. Sonnega, PhD, for their contributions to the design and successful implementation of this project.
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Dr. Coyne was supported by Grant HL45594-01A1 from the National Institutes of Health, Bethesda, Maryland, and Dr. Rohrbaugh was supported by Award 0051286Z from the American Heart Association, Dallas, Texas.