Patient and Spousal Health and Outcomes in Heart Failure

Abstract

Background A diagnosis of heart failure (HF) often requires a comprehensive lifestyle change to maintain disease stability. When patients with HF are married, the spouse frequently assumes the caregiving role. Our objectives were to describe the health of spouses of married patients with HF, and examine if the health of a spouse impacts patient outcomes. Methods and Results We identified 905 patients that were married at the time of incident HF diagnosis in Olmsted County, Minnesota from 2000-2012. Using Rochester Epidemiology Project resources, the patient and their spouse's comprehensive longitudinal health histories were linked. Spousal health at patient HF diagnosis was assessed by comorbidity burden, self-reported difficulty with activities of daily living (ADL) and prior hospitalizations. The associations of spousal health with patient outcomes and patient death with spousal outcomes were examined using Cox and Andersen-Gill models. Spouses of patients with HF were elderly (mean age 71 years), often had comorbid conditions, and 16% had difficulty with one or more ADLs. After adjustment for patient age, sex, and comorbidity, there were no independent associations of spousal health and patient risk of death or hospitalization after HF diagnosis. However, the risk of hospitalization (adjusted hazard ratio, HR, 1.34, 95% CI 1.11-1.60, p=0.002) and death (HR 2.10, 95% CI 1.60-2.75, p<0.001) increased in the surviving spouse after patient death. Conclusions We found no evidence that the health of a spouse impacts patient outcomes after HF diagnosis. However, after a patient with HF dies, their surviving spouse's risk of hospitalization and death increases.

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