The death of a family member can increase the risk of heart failure mortality

Washington [US]July 7 (): patients who experience grief or in grief after the loss of a close family member are at increased risk of dying, especially during the first week after the family member’s death, according to a new study.

Heart failure (HF) affects more than 64 million individuals worldwide. Previous study results suggest that depression, and low social support are associated with poor prognosis in HF patients. Many studies have also been conducted to confirm the link between severe emotional stress and Takotsubo cardiomyopathy, also known as “broken heart syndrome”. This study is one of the first to examine the link between death and HF risk.

The study authors looked at almost 500,000 patients from the Swedish Heart Failure Register during 2000-2018 and / or patients with primary diagnosis HF from the Swedish Patient Register during 1987-2018. Information on the date and cause of death of family members (children, spouse / partner, grandchildren, siblings and parents) was retrieved from the cause of death register. A total of 58,949 participants in the study experienced grief during the average 3.7 years of follow-up. The study authors analyzed whether the relationship to the deceased, cause of death or time elapsed since death affected the HF mortality risk.

The relationship between death and increased risk of HF mortality was observed after the death of a child (10% increased risk), spouse (partner (20% increased risk), grandchildren (5% increased risk) or siblings (13% increased risk) risk, but not after the death of a parent. The risk of dying in HF after the loss of a family member was highest during the first week of grief (a 78% increased risk), especially in the case of a child’s death (31% increased risk) or spouse / partner (a 113% increased risk) ; it was also higher at two losses (35% increased risk) as opposed to one loss (28% increased risk).

“The link between death and mortality was observed not only in cases of loss due to and other natural causes, but also in cases of unnatural deaths,” says Hua Chen, lead author of the study and doctoral student at Karolinska Institutet in , . “Our finding that death was associated with mortality in HF patients contributes to and expands the existing literature on the role of stress in the prognosis of HF and is consistent with studies reporting associations between deaths and increased risk of incidents with cardiovascular conditions.” The study authors said that death can activate the hypothalamic-pituitary-adrenal axis (HPA), an important neuroendocrine system that regulates stress and emotional response. The authors said that it can also trigger a reaction in the renin-angiotensin-aldosterone system (RAAS) and the , both of which are the main features of the neuroendocrine response in HF.

“The findings of the study may require increased attention from family members, friends and involved professionals for patients with grieving heart failure, especially during the period shortly after the loss,” said Krisztina Laszlo, senior author of the study and associate professor of the study. Department of Global Public at Karolinska Institutet.

The study has several limitations, including that the authors were unable to eliminate the confusing effects of genetic factors or unsaturated socioeconomic, lifestyle, or health-related factors shared by family members. The authors had limited opportunities to detect effects in some of the sub-analyzes and the results may only be generalized to with social and cultural contexts and health-related factors similar to Sweden. Future studies are needed to investigate whether less serious sources of stress can also contribute to a poor HF prognosis. (ANI)


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