Heart failure (HF) patients experiencing grief or in mourning following the loss of a close family member may be at an increased risk of death, particularly during the first week following the family member’s death, according to a study published July 6 in JACC: Heart Failure.

Hua Chen, MSc, et al., looked at almost 500,000 patients from the Swedish Heart Failure Registry during 2000-2018 and/or patients with a primary diagnosis of HF from the Swedish Patient Register during 1987-2018. Information on date and cause of family member deaths was obtained from the Cause of Death Register. A total of 58,949 study participants experienced bereavement during the mean 3.7 years of follow-up.

The association between bereavement and increased HF mortality risk was observed after death of a child (a 10% increased risk), spouse/partner (a 20% increased risk), grandchild (a 5% increased risk) or sibling (a 13% increased risk), but not after death of a parent. The risk of dying from HF after the loss of any family member was highest during the first week of bereavement (a 78% increased risk), particularly in the case of death of a child (a 31% increased risk) or spouse/partner (a 113% increased risk); it was also higher in the case of two losses (a 35% increased risk) as opposed to one loss (a 28% increased risk).

“The association between bereavement and mortality was not only observed in cases of loss due to cardiovascular disease and other natural causes, but also in cases of unnatural deaths,” said Chen, lead author of the study and a doctoral student at Karolinska Institutet in Stockholm, Sweden. “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.”

The study authors explain that bereavement may activate the hypothalamic-pituitary-adrenal axis, an important neuroendocrine system which regulates stress and emotional response. In addition, it may also trigger a reaction in the renin-angiotensin-aldosterone system and the sympathetic nervous system, both of which are the main features of the neuroendocrine response in HF.

“The findings of the study may call for increased attention from family members, friends and involved professionals for bereaved HF patients, particularly in the period shortly after the loss,” adds Krisztina László, PhD, senior author of the study.

Moving forward, “further studies are needed to investigate whether less severe sources of stress can also contribute to poor prognosis in HF and to explore the mechanisms underlying this association,” the authors conclude.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Parental Death, Sympathetic Nervous System, Heart Failure, Grief, Bereavement, Pituitary-Adrenal System, Renin-Angiotensin System, Hypothalamo-Hypophyseal System, Follow-Up Studies, Cause of Death, Sweden

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