Newswise – Patients with heart failure who suffer grief or grief after the loss of a close relative have a higher risk of death, especially during the first week after the death of the family member, according to a study published today in JACC : Heart Failure.
Heart failure (HF) affects more than 64 million people worldwide. The results of previous studies suggest that depression, anxiety, and low social support are associated with a poor prognosis in patients with HF. Many studies have also been done to confirm the relationship between severe emotional stress and Takotsubo cardiomyopathy, also known as “broken heart syndrome.” This study is one of the first to investigate the association between grief and the risk of HF.
The study authors analyzed nearly 500,000 patients from the Swedish Heart Failure Registry during the period 2000-2018 and / or patients with a primary diagnosis of HF from the Swedish Patient Registry during the period 1987-2018. Information on the date and cause of death of relatives (children, spouse, grandchildren, siblings and parents) was obtained from the Register of Causes of Death. A total of 58,949 study participants experienced grief during the mean 3.7-year follow-up. The study authors analyzed whether the relationship to death, cause of death, or time elapsed since death affected the risk of HF mortality.
The association between grief and increased risk of mortality from HF was observed after the death of a child (10% higher risk), a spouse / partner (20% higher risk), a grandson (5% more risk) or a sibling (13% more increase). risk), but not after the death of a father. The risk of dying from HF after the loss of a family member was higher during the first week of mourning (78% higher risk), especially in the case of the death of a child (a 31 % more risk) or spouse / partner (113% more risk); it was also greater in the case of two losses (35% more risk) than in one loss (28% more risk).
“The association between grief and mortality was not only observed in cases of loss due to cardiovascular disease and other natural causes, but also in cases of unnatural deaths,” said Hua Chen, lead author of the study and student doctorate at the Karolinska Institutet in Stockholm, Sweden. “Our finding that grief was associated with mortality in patients with HF contributes and expands the existing literature on the role of stress in the prognosis of HF and is consistent with studies reporting associations between grief and the increased risk of cardiovascular events “.
The study authors said that grief can activate the hypothalamic-pituitary-adrenal (HPA) axis, an important neuroendocrine system that regulates stress and emotional response. The authors said it can also trigger a reaction to the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system, both major features of the neuroendocrine response to HF.
“The results of the study may require increased care from family, friends and professionals involved for patients with heart failure in mourning, especially in the period shortly after the loss,” said Krisztina László, lead author of the study and associate professor of the study. Department of Global Public Health of the Karolinska Institutet.
The study has several limitations, including that the authors were unable to eliminate the confounding effects of unmeasured genetic or socioeconomic, lifestyle, or health-related factors shared by family members. The authors had limited chances of detecting effects in some of the subanalyses, and the findings can only be generalized to countries with similar social and cultural contexts and health-related factors in Sweden. Future studies are needed to investigate whether less severe sources of stress may also contribute to a poor prognosis of HF.
The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home of the entire cardiovascular care team, the mission of the College and its more than 56,000 members is to transform cardiovascular care and improve heart health. The ACC awards credentials to cardiovascular professionals who meet strict qualifications and lead the formation of health policies, standards, and guidelines. The College also offers professional medical education, disseminates cardiovascular research through its world-renowned JACC journals, manages national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more information, visit acc.org.
ACC’s family of JACC journals is among the best cardiovascular journals in the world for scientific impact. The flagship journal, the Journal of the American College of Cardiology (JACC) and a family of specialized journals consisting of JACC: Advances, JACC: Asia, JACC: Basic to Translational Science, JACC: CardioOncology, JACC: Cardiovascular Imaging, JACC: Cardiovascular Interventions, JACC: Case Reports, JACC: Clinical Electrophysiology, and JACC: Heart Failure: Proud to publish peer-reviewed major research on all aspects of cardiovascular disease. More information at JACC.org.
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