In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

Being unmarried is associated with a higher risk of death in heart failure patients

Heart Failure

Madrid, Spain – 21 May 2022:  Unmarried heart failure patients appear less confident in managing their condition and more socially limited compared to their married counterparts, according to research presented today at Heart Failure 2022, a scientific congress of the European Society of Cardiology (ESC).1 These differences may have contributed to the worse long-term survival observed in unmarried patients.

“Social support helps people managing long-term conditions,” said study author Dr. Fabian Kerwagen of the Comprehensive Heart Failure Center at the University Hospital Würzburg, Germany. “Spouses may assist with drug adherence, provide encouragement and help with developing healthier behaviours, all of which could affect longevity. In this study, unmarried patients exhibited fewer social interactions than married patients, and lacked confidence to manage their heart failure. We are exploring, whether these factors could also partially explain the link with survival.”

Previous studies have shown that being unmarried is an indicator of a less favourable prognosis both in the general population and in patients with coronary artery disease. This post-hoc analysis of the Extended Interdisciplinary Network Heart Failure (E-INH) study investigated the prognostic relevance of marital status in patients with chronic heart failure.

The E-INH study included 1,022 patients hospitalised between 2004 and 2007 for decompensated heart failure. Out of 1,008 patients providing information on marital status, 633 (63%) were married and 375 (37%) were unmarried including 195 widowed, 96 never married, and 84 separated or divorced.

At baseline, quality of life, social limitations and self-efficacy were measured using the Kansas City Cardiomyopathy Questionnaire, a questionnaire specifically designed for patients with heart failure. Social limitation refers to the extent to which heart failure symptoms affect patients’ ability to interact socially, such as pursuing hobbies and recreational activities, or visiting friends and family. Self-efficacy describes patients’ perception of their ability to prevent heart failure exacerbations and manage complications. Depressed mood was assessed using the Patient Health Questionnaire (PHQ-9).

There were no differences between married and unmarried patients regarding overall quality of life or depressed mood. However, the unmarried group scored worse on social limitations and self-efficacy compared with the married group.

During 10 years of follow-up, 679 (67%) patients died. Being unmarried versus married was associated with higher risks for all-cause death (hazard ratio [HR] 1.58, 95% confidence interval [CI] 1.31–1.92) and cardiovascular death (HR 1.83, 95% CI 1.38–2.42). Widowed patients carried the highest mortality risk, with hazard ratios of 1.70 and 2.22 for all-cause and cardiovascular death, respectively, compared to the married group.

Dr. Kerwagen said: “The connection between marriage and longevity indicates the importance of social support for patients with heart failure, a topic which has become even more relevant with social distancing during the pandemic. Health professionals should consider asking patients about their marital status and wider social group and recommending heart failure support groups to fill potential gaps. Education is crucial but health providers also need to boost patients’ confidence in their self-care abilities. We are working on a mobile health application which we hope will assist heart failure patients in the day-to-day management of their condition.”



Notes to editor

ESC Press Office
Tel: +33 (0) 7 8531 2036

Follow us on Twitter @ESCardioNews 


Funding: The INH study was supported by the German Federal Ministry of Education and Research (BMBF), Berlin, Germany (grant 01GL0304), Competence Network Heart Failure, Würzburg, Germany (BMBF grants 01GI0205/01GI1202A), and Comprehensive Heart Failure Center Würzburg, Würzburg, Germany (BMBF grants 01EO1004/01EO1504). This post-hoc analysis was conducted within Fabian Kerwagen’s DFG-UNION-CVD Clinician Scientist Program at the Integrative Clinician Scientist College (ICSC) Würzburg, a clinician-scientist program funded by the DFG (German Research Foundation).


Disclosures: None.


References and notes

1The abstract ‘Impact of marital status on long-term survival in patients with heart failure: results from the extended INH study’ will be presented during the session ‘Heart Failure ePosters - focus on Chronic Heart Failure’ which takes place on 21 May at 08:30 CEST at ePoster station 1.


About Heart Failure 2022 & World Congress on Acute Heart Failure
Heart Failure is the annual congress of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).

About the Heart Failure Association

The Heart Failure Association (HFA) is a branch of the European Society of Cardiology (ESC). Its aim is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.

About the European Society of Cardiology

The ESC brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.


Information for journalists about registration for Heart Failure 2022

Heart Failure 2022 takes place 21 to 24 May at IFEMA Madrid, Spain and online. Explore the scientific programme.

  • Free registration applies to accredited press.
  • Credentials: A valid press cardor appropriate letter of assignment with proof of three recent published articles. Read the ESC media and embargo policy.
  • The ESC Press Office will verify the documents and confirm by email that your press accreditation is valid.
  • The ESC Press Office decision is final regarding all press registration requests.

About the European Society of Cardiology

The ESC brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.