Grief following family member’s death may increase heart failure mortality risk, study finds

Heart failure patients experiencing grief after the loss of a close family member are at an increased risk of death, a new study has found.

The study, published on Wednesday in the journal JACC: Heart Failure, found that patients in mourning, particularly during the first week following the family member’s death, are at increased risk of death.

Researchers, including those from Karolinska Institutet in Sweden, say grieving the loss of a close family member can increase stress levels, which contributes to poor heart failure (HF) prognosis.

Earlier research has established that depression, anxiety and low social support are associated with poor prognosis in HF patients, with many past studies also confirming the relationship between severe emotional stress and Takotsubo cardiomyopathy – also known as “broken heart syndrome”.

In the new study, scientists looked at about 500,000 patients from the Swedish Heart Failure Registry between 2000 and 2018, and/or patients with a primary diagnosis of HF from the Swedish Patient Register during the period of 1987 to 2018.

Researchers also obtained data on date and cause of family member deaths from the Cause of Death Register.

Assessing the data, they found that 58,949 study participants experienced bereavement during the mean 3.7 years of follow-up.

The study also assessed whether relationship to deceased, cause of death or time passed since death affected HF mortality risk.

Researchers found an association between bereavement and increased HF mortality risk following the death of a child (a 10 per cent increased risk), spouse/partner (a 20 per cent increased risk), grandchild (a 5 per cent increased risk), or sibling (a 13 per cent increased risk), but not after the death of a parent.

They say the risk of dying from HF after the loss of any family member was highest during the first week of bereavement, with a 78 per cent increased risk.

The study found that this was particularly so in the case of death of a child or partner.

It was also higher in the case of two losses (a 35 per cent increased risk) as opposed to one loss (a 28 per cent increased risk).

“Our finding that bereavement was associated with mortality in HF patients contributes to and extends the existing literature regarding role of stress in prognosis of HF and is consistent with studies reporting associations between bereavement and increased risk of incident cardiovascular conditions,” study co-author Hua Chen said.

Researchers suspect bereavement activates the hypothalamic-pituitary-adrenal (HPA) axis, an important neuroendocrine system which regulates stress and emotional response.

It may also trigger a reaction in the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system, which are main features of the neuroendocrine response in HF, they say.

“The findings of the study may call for increased attention from family members, friends and involved professionals for bereaved heart failure patients, particularly in the period shortly after the loss,” Krisztina Laszlo, another author of the study, said.

Citing some of the limitations of the study, scientists said they could not eliminate the confounding effects of genetic factors or unmeasured socioeconomic, lifestyle or health-related factors shared by family members.

Researchers say the findings may also be generalised only to countries with social and cultural contexts and health-related factors similar to Sweden.

In future studies, they hope to assess whether less severe sources of stress may also contribute to poor HF prognosis.