Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
JACC Heart Fail. 2022 Oct;10(10):753-764. doi: 10.1016/j.jchf.2022.05.005. Epub 2022 Jul 6.
BACKGROUND: The role of stress in the prognosis of heart failure (HF) is unclear. This study investigated whether the death of a close family member, a severe source of stress, is associated with mortality in HF. OBJECTIVES: This study assessed whether the death of a close family member is associated with mortality in HF. METHODS: Patients from the Swedish Heart Failure Registry during 2000-2018 and/or in the Swedish Patient Register with a primary diagnosis of HF during 1987-2018 (N = 490,527) were included in this study. Information was obtained on death of family members (children, partner, grandchildren, siblings, and parents), mortality, sociodemographic variables, and health-related factors from several population-based registers. The association between bereavement and mortality was analyzed by using Poisson regression. RESULTS: Loss of a family member was associated with an increased risk of dying (adjusted relative risk: 1.29; 95% CI: 1.27-1.30). The association was present not only in case of the family member's cardiovascular deaths and other natural deaths but also in case of unnatural deaths. The risk was higher for 2 losses than for 1 loss and highest in the first week after the loss. The association between bereavement and an increased mortality risk was observed for the death of a child, spouse/partner, grandchild, and sibling but not of a parent. CONCLUSIONS: Death of a family member was associated with an increased risk of mortality among patients with HF. Further studies are needed to investigate whether less severe sources of stress can also contribute to poor prognosis in HF and to explore the mechanisms underlying this association.
背景:压力在心力衰竭(HF)预后中的作用尚不清楚。本研究旨在探讨直系亲属的死亡,这一严重的应激源,是否与 HF 患者的死亡率相关。
目的:评估直系亲属的死亡是否与 HF 患者的死亡率相关。
方法:本研究纳入了 2000 年至 2018 年期间来自瑞典心力衰竭注册登记处的患者和/或 1987 年至 2018 年期间来自瑞典患者登记处的有原发性 HF 诊断的患者(N=490527)。通过几个基于人群的登记处获得了关于家庭成员(子女、配偶、孙子女、兄弟姐妹和父母)死亡、死亡率、社会人口统计学变量和健康相关因素的信息。使用泊松回归分析丧亲与死亡率之间的关系。
结果:失去家庭成员与死亡风险增加相关(调整后的相对风险:1.29;95%CI:1.27-1.30)。这种关联不仅存在于家庭成员的心血管死亡和其他自然死亡的情况下,也存在于非自然死亡的情况下。与 1 次损失相比,2 次损失的风险更高,且在损失后的第一周风险最高。丧亲与死亡率增加的风险之间存在关联,无论是子女、配偶/伴侣、孙子女和兄弟姐妹的死亡,还是父母的死亡。
结论:家庭成员的死亡与 HF 患者的死亡率增加相关。需要进一步研究来探讨其他不太严重的应激源是否也会导致 HF 预后不良,并探索这种关联的潜在机制。
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