Heart failure
Effect of Marital Quality on Eight-Year Survival of Patients With Heart Failure

https://doi.org/10.1016/j.amjcard.2006.05.034Get rights and content

Recent evidence suggests that psychosocial factors such as self-efficacy, psychological distress, perceived social support, and marital quality have prognostic significance for morbidity and mortality after heart failure. Previously, we reported that interview and observational measures of marital quality obtained from 189 patients with heart failure (139 men and 50 women) and their spouses predicted all-cause patient mortality during the next 4 years, independent of the baseline illness severity (New York Heart Association class). We present additional follow-up results for this sample, with Cox regression analyses showing that a couple-level composite measure of marital quality continued to predict survival during an 8-year period (p <0.001), especially when the patient was a woman, and did so substantially better than individual (patient-level) risk and protective factors, such as psychological distress, hostility, neuroticism, self-efficacy, optimism, and breadth of perceived emotional support. In conclusion, relationship factors may be especially relevant in managing a difficult chronic condition such as heart failure, which makes stringent and complex demands on patients and their families.

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.

References (23)

  • J.C. Coyne et al.

    Couples coping with a myocardial infarction: a contextual perspective on wives’ distress

    J Pers Soc Psychol

    (1991)
  • Cited by (0)

    1

    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.

    View full text