Who's More at Heart Disease Risk — Married People or Unmarried People?

Being unmarried can increase the risk of death in heart failure patients. Therefore, social support is important to increase their longevity.

Unmarried people were found to be more at risk of developing heart disease. Also, they appear to be less confident in managing their condition and are socially limited than their married counterparts, reveals a new study.//

The research was presented at Heart Failure 2022, a scientific congress of the European Society of Cardiology (ESC). These differences may have contributed to the worse long-term survival observed in unmarried patients.

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‘Social support for patients with heart failure is important to increase their longevity.’

“Social support helps people manage long-term conditions,” said study author Dr. Fabian Kerwagen of the Comprehensive Heart Failure Center at the University Hospital Würzburg, Germany.

“Spouses may assist with drug adherence, provide encouragement and help with developing healthier behaviors, all of which could affect longevity. In this study, unmarried patients exhibited fewer social interactions than married patients, and lacked the confidence to manage their heart failure. We are exploring, whether these factors could also partially explain the link with survival.”

Studies on Heart Failure: Married Versus Unmarried

Previous studies have shown that being unmarried 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 investigated the prognostic relevance of marital status in patients with chronic heart failure.

The E-INH study included 1,022 patients hospitalized between 2004 and 2007 for decompensated heart failure. Out of 1,008 patients providing information on marital status, 633 (63%) were married and 375 (37%) were unmarried including 195 widowed, 96 never married, and 84 separated or divorced.

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At baseline, 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 limitation refers to the extent to which heart failure symptoms affect patients’ ability to interact socially, such as pursuing hobbies and recreational activities, or visiting friends and family.

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Self-efficacy describes patients’ perception of their ability to prevent heart failure exacerbations and manage complications. Depressed mood was assessed using the Patient Health Questionnaire (PHQ-9).

There were no differences between married and unmarried patients regarding the overall quality of life or depressed mood. However, the unmarried group scored worse on social limitations and self-efficacy compared with the married group.

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During 10 years of follow-up, 679 (67%) patients died. Being unmarried versus married was associated with higher risks for all-cause death (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 carried the highest mortality risk, with hazard ratios of 1.70 and 2.22 for all-cause and cardiovascular death, respectively, compared to the married group.

Dr. Kerwagen said: “The connection between marriage and longevity indicates the importance of social support for patients with heart failure, a topic which has become even more relevant with social distancing during the pandemic. Health professionals should consider asking patients about their marital status and wider social group and recommending heart failure support groups to fill potential gaps. Education is crucial but health providers also need to boost patients’ confidence in their self-care abilities. We are working on a mobile health application which we hope will assist heart failure patients in the day-to-day management of their condition.”

Source-Eurekalert