Marriage bears survival benefits in heart failure

Unmarried patients with left ventricular dysfunction and an implantable cardioverter defibrillator (ICD) appear to be at a greater risk of death from mild heart failure (HF) than their married counterparts, a recent study has shown.

“There are several possible reasons that may explain the observed protective effect of being married, with the most common one being the presence of social support,” researchers said.

The study had 937 married and 344 unmarried enrolees. Over a median follow-up of 5.6 years, 137 participants died from any cause and 272 sustained HF events.

Kaplan-Meier survival curves found that the rate of all-cause mortality at 7 years was significantly lower in those who were married (20 percent vs 28 percent; p=0.026). This was confirmed through multivariate Cox proportional hazards regression modelling (hazard ratio [HR], 0.61, 95 percent confidence interval [CI], 0.44–0.84; p=0.003).

Disaggregation by device type showed that the protective effect of marital status remained significant in those with ICD implants (HR, 0.46, 95 percent CI, 0.30–0.71; p<0.001), but not in recipients of cardiac resynchronization therapy with defibrillators (HR, 0.84, 95 percent CI, 0.52–1.37; p=0.490).

Moreover, marriage also does not seem to prevent the occurrence of HF events (HR, 0.88, 95 percent CI, 0.68–1.15; p=0.351).

Further stratification by sex found that in ICD patients, males benefited from marriage the most, having significantly reduced mortality at 7 years than their unmarried comparators (27 percent vs 51 percent; p=0.002). No such effect was reported for females (p=0.349).