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Lifelong Bachelor Status Significant Predictor of Death in Men, Not Women, with Heart Failure


ACC 2023. In an analysis of patients with heart failure, never having been married was associated with worse survival compared with having been married.

©Monkey Business/AdobeStock

©Monkey Business/AdobeStock

Men who were lifelong bachelors were more than twice as likely to die within approximately 5 years after a diagnosis of heart failure (HF) compared with women of any marital status or men who were previously married, according to a secondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA).

The findings, which will be presented at the American College of Cardiology’s (ACC) 72nd Annual Scientific Session Together with the World Congress of Cardiology, being held March 4-6, 2023, in New Orleans, offer new evidence that an individual’s gender and marital status can influence their cardiovascular disease risk and prognosis.

“There is a relationship between a person’s relationship status and their clinical prognosis [with heart failure], and it’s important to figure out why that is,” said lead author Katarina Leyba, MD, a resident physician at the University of Colorado, in an ACC press release. “As our population is getting older and living longer, it’s imperative to determine how to best support the population through the aging process, and that might not be as easy as taking a pill. We need to take a personalized and holistic approach to supporting patients, especially with a chronic disease process like heart failure.”

MESA is a prospective study that enrolled 6800 participants aged 45-84 years. Among the 94 participants with HF at year 10 of the study, researchers compared survival rates from the time of HF diagnosis by gender and marital status over an average follow-up period of 4.7 years.

The association between all-cause mortality from time of HF diagnosis and marital status was determined using Cox proportional hazards models then separated by gender and adjusted for age and mood status, according to the study abstract.


In a univariable analysis, results showed that never having been married was associated with worse survival in patients with HF (hazard ratio [HR] 1.60, p=.02) compared with married participants. This held true when adjusted for age (HR 1.61, p=.02), according to the study abstract.

When participants were separated by gender, the research team observed that marital status was not a significant predictor of mortality in women, however, never married status remained a significant predictor of death in men (HR 2.16, p=.009).

In a multivariable analysis, never married status was associated with increased mortality in men relative to being married (HR 2.21, p=.008), but being widowed, divorced, or separated was not (p=.28, p=.86, and p=.80, respectively), added investigators in the abstract.

Researchers said that the reasons behind the association between a man’s marital status and mortality risk after a HF diagnosis warrants further study. Potential drivers may include social interaction or isolation, which can impact mood and overall health; access to caregiver support for help with home health monitoring, medication adherence, and transportation to medical appointments; or differences in health behaviors, such as diet, physical activity, and alcohol consumption. It is likely, said investigators, that different factors play a role for different patients, so being aware of a patient’s situation at home can help to guide more personalized approaches for managing their health.

Leyba will present the study, “Lifelong Bachelor Status Is Associated with Increased Mortality in Men With Heart Failure—A Secondary Analysis of the Multi-Ethnic Study of Atherosclerosis,” on Saturday, March 4, 2023 at 3 pm CT / 21:00 UTC in the Heart Failure and Cardiomyopathies Moderated Poster Theater 9, Hall F.

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