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Never-Married Men Diagnosed with Heart Failure Have Increased Risk of Death

New research shows that women and currently or previously married men are at lower risk of dying following a heart failure diagnosis.

Written by Rachel Sauer on April 19, 2023

Bad news, confirmed bachelors: If you’re diagnosed with heart failure, you’re at greater risk of dying sooner than women or previously married men who receive a similar diagnosis, new research shows.

However, this doesn’t mean that never-married men should reach out in a panic to the one who got away, because an important research takeaway is the growing emphasis on practicing whole-person medicine – that is, “looking at the whole of a patient’s life and considering factors beyond scans and test results,” says Katarina Leyba, MD, a second-year internal medicine resident in the University of Colorado School of Medicine who worked with research mentor David Kao, MD, on the study.

“My view is a very holistic approach to figuring out how to work with people on their health and whatever conditions they may have,” explains Kao, an associate professor of cardiology in the CU School of Medicine. “That can include everything from genetics to relationships and living situation. There are a lot of factors in a person’s life, beyond what we see on a scan, that can affect outcomes.”

Outcomes associated with heart failure

The idea for the research originated with the concept of holistic medicine and a desire to better understand whether or how social and interpersonal factors can impact a person’s health, especially in relation to chronic diseases such as heart failure, Leyba says.

“There’s not a lot of research studying how men and women differ in the importance of their social and relationship status on health outcomes, and the long-term impact those factors may have,” Kao says. “There’s been research in other disease states demonstrating that women tend to do better than men after their spouse dies, whereas men tend to have worse outcomes when their spouse dies, so we decided to look upstream of that. If you can discern why those associations are there, it may help us develop earlier and better interventions.”

Leyba and Kao focused on differences in outcomes associated with heart failure, which affects more than 6.5 million Americans. They used data from the Multi-Ethnic Study of Atherosclerosis, a multi-site, prospective medical research study involving a population-based sample of more than 6,800 men and women ages 45 to 85.

They determined marital status – which included married, widowed, divorced, separated, or never married – then looked at the association between all causes of death from the time of a heart failure diagnosis and marital status. They then separated the data by gender and adjusted for age and other factors.

Growing networks of support

Analyzing the data within those parameters, Leyba and Kao found that men who never had been married had worse survival outcomes from heart failure than people who are or previously had been married. When they separated the data by gender, they also found that marital status was not a significant predictor of death in women diagnosed with heart failure, but that never-married status remained a significant predictor of mortality in men diagnosed with heart failure.

Further, being widowed, divorced, or separated was not associated with increased mortality in men relative to being married. Leyba will present these findings at the Heart Failure & World Congress on Acute Heart Failure 2023 on May 22 in Prague, Czechia.

“One of the things these results tell me is that it’s kind of myopic to think medications are the only thing keeping patients with heart failure alive,” Kao says. “There’s a lot more to health and outcomes – we need to be trying to gain a better understanding of our patients’ quality of life. Are they isolated? Do they have a support network? Are they able to cook healthy meals? How’s their mental health?

“For example, I had a patient come in for one thing that was really bothering them, but I ended up learning that they had really serious depression issues that were currently informing their cardiac concerns. We spent a lot of time in clinic not talking about their heart at all. So, as clinicians we need to be talking with patients about the context they’re living in, about what matters most to them, what behavior changes are reasonable to try for.”

Kao adds that an aim of the research is not to reprimand or blame never-married men, but to continue working to understand their increased risk of death after a heart failure diagnosis and to grow networks of support they can access even before getting to the point of heart failure.

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David Kao, MD

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Katarina Leyba, MD