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• Posted February 23, 2023

Lifelong Bachelors Fare Worse When Heart Failure Strikes

When heart failure strikes, being a lifelong bachelor may mean you might die sooner than women or previously married men diagnosed with the same condition, a new study suggests.

Lifetime marital history appears to be an important predictor of survival in men with heart failure, but not women. Specifically, lifelong bachelors had significantly worse long-term survival than men who had been married, separated, divorced or widowed, said senior researcher Dr. David Kao, an associate professor of medicine at the University of Colorado School of Medicine in Aurora.

In contrast, women with heart failure who had never been married did not appear to be at higher risk of death than those who had, he added.

"These findings suggest that marriage has some kind of beneficial effect for men that helps them survive longer after developing heart failure," Kao said. "At present, we have not identified precisely what these effects are, but they could include health-seeking behaviors, socioeconomic and family support in older age, or differences in factors like frailty and nutrition, and mood."

The lack of difference in survival between women with different marital histories could indicate that either the same factors are not as clinically beneficial in women or possibly that there are fewer deficits in those traits that are affected through marriage, Kao said.

With heart failure, the heart becomes too weak or stiff to pump blood to the body effectively. There is no cure for heart failure, but medications, dietary modifications and regular physical activity can help patients live longer and reduce symptoms such as shortness of breath, fatigue and swelling.

For the study, Kao's team used data on 6,800 American adults aged 45 to 84. Among the 94 participants who suffered from heart failure at year 10 of the study, the researchers compared survival rates from when heart failure was diagnosed and marital status over an average follow-up of five years.

The investigators found that men who had never been married were more than twice as likely to die within roughly five years after diagnosis than women of any marital status.

Lifelong bachelors were about two times more likely to die than men who were married. Moreover, widowed, divorced or separated men were not at an increased risk of dying, compared with married men, the researchers noted.

"Non-medical factors, such as relationship history, can have a significant impact on the course of heart failure," Kao said. "Furthermore, these factors may not carry the same importance for all groups; in this case, relationship history appears to be much more important in men than women. Recognition of these factors may help identify new interpersonal strategies that could help improve the ability of patients to cope with heart failure."

The findings are scheduled for presentation March 4 at the annual meeting of the American College of Cardiology, in New Orleans. Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

Heart failure is among the leading causes of cardiovascular-related hospitalizations and death, said Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center and co-chief of the UCLA division of cardiology in Los Angeles.

"Social determinants of health are increasingly recognized as important contributors to the risk of heart failure and mortality among individuals with established heart failure," Fonarow said.

"Medical therapies, when prescribed and adhered to, can markedly reduce the risk of mortality in men and women with heart failure," he said. It might be that bachelors are less likely to adhere to their medications, which may affect their survival, he suggested.

"While further studies are needed to explore the potential mechanisms for these observed associations, it is possible that marital status could influence the use and adherence to these beneficial therapies," Fonarow said.

To combat these problems, Kao's group suggested that doctors talk with patients about their home life and consider how their relationships might affect their heart failure prognosis.

More information

For more on heart failure, head to the American Heart Association.

SOURCES: David Kao, MD, associate professor, medicine, University of Colorado School of Medicine, Aurora; Gregg Fonarow, MD, director, Ahmanson-UCLA Cardiomyopathy Center, and co-chief, UCLA Division of Cardiology, Los Angeles; presentation, American College of Cardiology meeting, New Orleans, March 4, 2023