Grief, Death of a Family Member May Increase Mortality Risk for Patients with Heart Failure

Patients with heart failure (HF) experiencing grief or mourning following the loss of a close family member are at an increased risk of death, according to a study published in JACC: Heart Failure. The risk of death was found to be highest during the first week following the family member’s death, particularly after the death of a child or spouse.

The study, one of the first to investigate the association between bereavement and HF risk, included almost 500,000 patients from the Swedish Heart Failure Registry during 2008-2018 and/or patients with a primary diagnosis of HF from the Swedish Patient Register during 1987-2018. Information on date and cause of family member deaths was obtained from the Cause of Death Register. Family member deaths included the death of children, spouses/partners, grandchildren, siblings, and parents.

A total of 58,949 participants were found to have experienced bereavement during the mean 3.7 years of follow-up. The researchers analyzed whether relationship to the deceased, cause of death, or time passed since death affected HF mortality risk.

The greatest increase in HF mortality risk was observed after the death of a spouse/partner, which had a 20% increased risk. Increases were also observed after the death of a child (10%), grandchild (5%), or sibling (13%).

No association between bereavement and increased HF mortality risk was observed after the death of a parent. The risk of death from HF after the loss of a family member was found to be highest during the first week of bereavement with a 78% increased risk, particularly in the case of death of a child (31% increased risk) or spouse/partner (113% increased risk).

Increase in HF mortality risk was also higher in the case of 2 losses (35%) than 1 loss (28%). The authors of the study suggested that bereavement may activate the hypothalamic-pituitary-adrenal axis, an important neuroendocrine system, which regulates stress and emotional response.

Additionally, it may trigger a reaction in the renin-angiotensin-aldosterone system and the sympathetic nervous system, main features of the neuroendocrine response in HF.

“The association between bereavement 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,” lead study author Hua Chen, a doctoral student at Karolinska Institutet in Stockholm, Sweden, said in a press release.

Previous research has shown associations between depression, anxiety, and low social support and poor prognosis in HF patients. Additionally, studies have confirmed a relationship between severe emotional distress and Takotsubo cardiomyopathy, often titled “broken heart syndrome.”

“Our finding that bereavement was associated with mortality in HF patients contributes to and extends the existing literature regarding role of stress in prognosis of HF and is consistent with studies reporting associations between bereavement and increased risk of incident cardiovascular conditions,” Chen said.

The study faced several limitations. The researchers were unable to eliminate the confounding effects of genetic factors or unmeasured socioeconomic, lifestyle, or health-related factors shared by family members. The findings of the study may only be generalized to countries with social and cultural contexts and health-related factors similar to Sweden.

The authors encourage future studies to investigate whether less severe sources of stress may also contribute to poor HF prognosis.

“The findings of the study may call for increased attention from family members, friends and involved professionals for bereaved heart failure patients, particularly in the period shortly after the loss,” concluded Krisztina László, senior author of the study and an associate professor from the Department of Global Public Health at Karolinska Institutet, in a statement.

Reference

Death of a family member may increase heart failure mortality risk. EurekAlert. News Release. July 6, 2022. Accessed July 7, 2022. https://www.eurekalert.org/news-releases/957613.