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American Journal of Critical Care. 2009;18: 562-570 doi:10.4037/ajcc2009388
Copyright © 2009 by the American Association of Critical-Care Nurses.
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Marital Status as an Independent Predictor of Event-Free Survival of Patients With Heart Failure

By Misook L. Chung, RN, PhD, Terry A. Lennie, RN, PhD, Barbara Riegel, RN, DNSc, Jia-Rong Wu, RN, PhD, Rebecca L. Dekker, RN, MSN and Debra K. Moser, RN, DNSc. Misook L. Chung is an assistant professor, Jia-Rong Wu is a postdoctoral fellow, and Rebecca L. Dekker is a doctoral student in the College of Nursing, Terry A. Lennie is director of the doctoral program and codirector of the RICH Heart Program, College of Nursing and Graduate Center for Nutritional Sciences, and Debra K. Moser is a professor and holder of the Gill Endowed Chair and co-director of the RICH Heart Program at the University of Kentucky, Lexington, Kentucky. Barbara Riegel is a professor in the School of Nursing at the University of Pennsylvania, Philadelphia.

Corresponding author: Misook L. Chung, RN, PhD, College of Nursing, University of Kentucky, 529 CON, 760 Rose St, Lexington, KY 40536-0232 (e-mail: misook.chung{at}uky.edu).

Background Depressive symptoms are a well-known predictor of mortality in patients with heart failure, and positive spousal support is associated with improved outcomes in these patients. However, in the context of depressive symptoms, the effect on survival of having a spouse is unknown.

Objective To determine the effect of marital status on event-free survival in patients with heart failure who did or did not have depressive symptoms.

Methods Depressive symptoms were assessed by using the Beck Depression Inventory-II in patients with heart failure who were followed-up for up to 4 years to collect data on mortality and hospitalizations. Patients were grouped according to the presence and absence of depressive symptoms by using the standard cutoff score of 14 on the Beck Depression Inventory-II. Kaplan-Meier and Cox regression analyses were used to compare event-free survival for married and nonmarried patients who were stratified according to the presence or absence of depressive symptoms.

Results Of 166 patients, 56% were married, and 33% had depressive symptoms. Levels of depressive symptoms were similar between married and nonmarried patients (10.9 vs 12.1; P = .39). Married patients experienced longer event-free survival than did nonmarried patients (P = .009), even with stratification according to depressive symptoms (P = .01).

Conclusions Patients with a spouse had longer event-free survival than nonmarried patients did, even in the context of depressive symptoms.






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Copyright © 2009 by the American Association of Critical-Care Nurses.