WASHINGTON – Marital status plays an underappreciated role in heart failure prognosis.
Indeed, having a life partner was independently associated with a 12% reduction in the risk of all-cause mortality or hospitalization during a median follow-up of 2.5 years in the randomized HF-ACTION trial, Dr. Robert J. Mentz reported at the annual meeting of the American College of Cardiology.
Dr. Robert J. Mentz
HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes in Exercise Training) was an 82-center, randomized trial examining the effects of exercise training in 2,331 heart failure patients with a left ventricular ejection fraction of 35% or less. The primary outcome has been reported previously (JAMA 2009;301:1439-50). In this new secondary analysis, Dr. Mentz and coinvestigators scrutinized the independent impacts of marital status, education level, and economic status on outcomes.
Of HF-ACTION participants, 61% had a current life partner at baseline, 60% had more than a high school education, and 59% had an annual income of at least $25,000. In a multivariate analysis controlling for demographics, comorbid conditions, heart failure etiology, and other potential confounders, life partner status was independently associated with a 12% lower composite event rate for all-cause mortality/hospitalization; education level and income didn’t have significant prognostic value, according to Dr. Mentz, a cardiologist at Duke University, Durham, N.C.
As this was a secondary analysis, the findings should be considered hypothesis generating. "Future prospective studies of social support interventions may be warranted to improve outcomes in this patient population," he observed.
Modern management of heart failure is complex, and fatigue is a prominent symptom. Possible mechanisms that might explain the observed benefit of life partnership in terms of patient outcomes include having someone at home to make sure the patient is taking medications appropriately. The spouse or life partner can also function as a second set of ears during clinic visits.
"When you’re in the physician’s office and information and instructions are coming at you like water out of a fire hose, your partner is there to write things down and help you remember points," Dr. Mentz noted.
The HF-ACTION trial was sponsored by the National Heart, Lung, and Blood Institute. Dr. Mentz reported having no relevant financial interests.