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Death of family member may raise chance of dying from heart failure

by Pragati Singh

According to a new study, heart failure patients who are in grief or grieving after the death of a close family member are at a higher risk of mortality, particularly in the first week after the death.

More than 64 million people worldwide suffer from heart failure (HF). Previous research has linked sadness, anxiety, and a lack of social support to a poor outcome in HF patients. Many studies have also been undertaken to confirm the link between Takotsubo cardiomyopathy, popularly known as “broken heart syndrome,” and extreme emotional stress. This is one of the first studies to look into the link between grieving and HF risk.

The researchers examined over 500,000 individuals from the Swedish Heart Failure Registry between 2000 and 2018 and/or patients with a main diagnosis of HF from the Swedish Patient Register between 1987 and 2018. The Cause of Death Register was used to acquire information on the date and cause of death of family members (children, spouse/partner, grandkids, siblings, and parents). During the average 3.7 years of follow-up, 58,949 research participants were bereaved.

The researchers investigated whether the deceased’s connection, the reason of death, or the period since death increased the likelihood of HF mortality.

The relationship between bereavement and higher HF mortality risk was detected after the loss of a child (10% increased risk), spouse/partner (20% increased risk), grandchild (5% increased risk), or sibling (13%) but not after the death of a parent.

The risk of dying from HF after the death of any family member was highest during the first week of bereavement (a 78 percent increased risk), especially in the case of death of a child (a 31 percent increased risk) or spouse/partner (a 113 percent increased risk); it was also higher in the case of two losses (a 35 percent increased risk) as opposed to one loss (a 35 percent increased risk) (a 28 percent increased risk).

“The relationship between grieving and mortality was detected not just in situations of loss due to cardiovascular illness and other natural causes, but also in cases of unnatural deaths,” said Hua Chen, the study’s principal author and a PhD student at Karolinska Institutet in Stockholm, Sweden.

“Our result that grieving was linked with mortality in HF patients adds to and expands on the current literature on the role of stress in HF prognosis, and it is consistent with studies indicating links between grief and higher risk of incident cardiovascular diseases.”

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According to the study’s authors, grief may stimulate the hypothalamic-pituitary-adrenal (HPA) axis, a critical neuroendocrine system that governs stress and emotional reaction.According to the scientists, it may also cause a reaction in the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system, which are both important components of the neuroendocrine response in HF.

“The study’s findings may call for increased attention from family members, friends, and involved professionals for bereaved heart failure patients, particularly in the period immediately following the loss,” said Krisztina Laszlo, senior author of the study and an associate professor at Karolinska Institutet’s Department of Global Public Health.

The investigators were unable to exclude the confounding effects of genetic characteristics or unmeasured socioeconomic, lifestyle, or health-related factors shared by family members, which is one of the study’s weaknesses.

The authors’ ability to identify impacts in several of the sub-analyses was restricted, and the findings may only be applied to nations with similar social and cultural backgrounds and health-related characteristics to Sweden. Future research is required to determine if less severe forms of stress might also contribute to a worse HF prognosis.

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