Effect of marital status on clinical outcome of heart failure

Background: Despite significant advances in pharmacological and nonpharmacological treatment of heart failure (HF), there are more than 1 million HF visits annually to the emergency department. Studies indicate that HF clinical outcome is affected not only by medical interventions but also by social factors such as marital status. Objectives: This study aimed to determine the effect of marital status of HF patients on clinical outcome of HF in a high-risk population. Methods: We reviewed data collected for The Joint Commission in patients admitted with HF at a university hospital serving a high-risk population in Louisiana during the period from June 2003 to September 2004 and followed up until December 2008. Patients were divided into 2 groups, namely, married patients and unmarried patients (including single, divorced, and widowed) based on self-reporting. Primary outcome measures were in-hospital survival and time to readmission. Secondary outcome measures were HF admission rate, average B-type natriuretic peptide, and average troponin-I levels throughout the follow-up period. Results: Of 646 reviewed records, 542, representing 357 patients, were included in the analysis. Of these, 105 patients were married and 245 were unmarried; marital status was missing for 7 patients. Mean (SD) of follow-up period was 2.39 (1.6) years. Marital status was not a significant variable for in-hospital death (hazard ratio, 0.71; 95% confidence interval, 0.35-1.49), or for time to readmission for HF (hazard ratio, 1.16; 95% confidence interval, 0.86-1.56); multiple linear regression analysis identified married status as an independent variable for average B-type natriuretic peptide (parameter estimate = -0.26, P = 0.02) but not for HF admission rate or average troponin-I levels. Conclusions: Married status was not associated with better clinical outcome in HF patients in a high-risk population.