Impact of Partner Bereavement on Quality of Cardiovascular Disease Management

Shah, Sunil; Carey, Iain M.; DeWilde, Stephen; Victor, Christina; Cook, Derek G

doi:10.1161/circulationaha.113.004122

Cited by 27 publications

(20 citation statements)

References 34 publications

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“…Unfortunately, our analysis is underpowered to resolve whether this possible protection results from medication use, history of disease, or other unmeasured factors. However, we have recently shown that bereaved patients have poorer medication coverage before and immediately after bereavement, 32 so our findings may also reinforce the importance of adherence to a medication regimen in reducing the health impact of bereavement.…”

Section: Related Literaturesupporting

confidence: 71%

“…We have previously shown that prescribing medication to lower lipid levels, antiplatelet medication, and drugs acting on the renin-angiotensin system fall in the immediate peribereavement period in patients at high risk of cardiovascular disease. 32 Longer-term behavioral changes affecting lifestyle factors, such as smoking and alcohol consumption, may also eventually contribute. 27 The absolute contribution of bereavement to overall cardiovascular event rates is likely to be small, because partner bereavement is usually a nonrepeated event for an indi-vidual, and the higher risk is relatively short-term.…”

Section: Interpretation and Implicationsmentioning

confidence: 99%

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Increased Risk of Acute Cardiovascular Events After Partner Bereavement

et al. 2014

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IMPORTANCE The period immediately after bereavement has been reported as a time of increased risk of cardiovascular events. However, this risk has not been well quantified, and few large population studies have examined partner bereavement. OBJECTIVE To compare the rate of cardiovascular events between older individuals whose partner dies with those of a matched control group of individuals whose partner was still alive on the same day. DESIGN, SETTING, AND PARTICIPANTS Matched cohort study using a UK primary care database containing availale data of 401 general practices from February 2005 through September 2012. In all, 30 447 individuals aged 60 to 89 years at study initiation who experienced partner bereavement during follow-up were matched by age, sex, and general practice with the nonbereaved control group (n = 83 588) at the time of bereavement. EXPOSURES Partner bereavement. MAIN OUTCOMES AND MEASURES The primary outcome was occurrence of a fatal or nonfatal myocardial infarction (MI) or stroke within 30 days of bereavement. Secondary outcomes were non-MI acute coronary syndrome and pulmonary embolism. All outcomes were compared between the groups during prespecified periods after bereavement (30, 90, and 365 days). Incidence rate ratios (IRRs) from a conditional Poisson model were adjusted for age, smoking status, deprivation, and history of cardiovascular disease. RESULTS Within 30 days of their partner's death, 50 of the bereaved group (0.16%) experienced an MI or a stroke compared with 67 of the matched nonbereaved controls (0.08%) during the same period (IRR, 2.20 [95% CI, 1.52-3.15]). The increased risk was seen in bereaved men and women and attenuated after 30 days. For individual outcomes, the increased risk was found separately for MI (IRR, 2.14 [95% CI, 1.20-3.81]) and stroke (2.40 [1.22-4.71]). Associations with rarer events were also seen after bereavement, including elevated risk of non-MI acute coronary syndrome (IRR, 2.20 [95% CI, 1.12-4.29]) and pulmonary embolism (2.37 [1.18-4.75]) in the first 90 days. CONCLUSIONS AND RELEVANCE This study provides further evidence that the death of a partner is associated with a range of major cardiovascular events in the immediate weeks and months after bereavement. Understanding psychosocial factors associated with acute cardiovascular events may provide opportunities for prevention and improved clinical care.

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Section: Related Literaturesupporting

confidence: 71%

Section: Interpretation and Implicationsmentioning

confidence: 99%

Increased Risk of Acute Cardiovascular Events After Partner Bereavement

et al. 2014

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“…A recent study found that individuals had fewer cardiovascular process of care measures (i.e. blood pressure, and cholesterol measures) and reduced medication refills in the year preceding spousal bereavement compared to matched controls (31); these results suggest diminished doctor and self-management of existing conditions in the year leading up to spousal bereavement and may explain why health deteriorations begin before bereavement. Although formal testing did not find evidence of new or worsening chronic conditions mediating the impact of bereavement on risk of death, it is possible that the health declines occur prior to bereavement (8).…”

Section: Discussionmentioning

confidence: 99%

Does the “Widowhood Effect” Precede Spousal Bereavement? Results from a Nationally Representative Sample of Older Adults

Vable

Subramanian

Rist

et al. 2015

The American Journal of Geriatric Psychiatry

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Objective Increased mortality risk following spousal bereavement (often called the “widowhood effect”) is well documented, but little prior research has evaluated health deteriorations preceding spousal loss. Design Data are from the Health and Retirement Study, a nationally representative sample of Americans over 50 years old. Method Individuals who were married in 2004 were considered for inclusion. Outcome data from 2006 on mobility (walking, climbing stairs), number of depressive symptoms, and instrumental activities of daily living (IADLs) were used. Exposure was characterized based on marital status at the time of outcome measurement: “recent widows” (N = 396) were bereaved between 2004 and 2006, before outcomes were assessed; “near widows” (N = 380) were bereaved between 2006 and 2008, after outcomes were assessed; “married” individuals (N = 7,330) remained married from 2004 to 2010, the follow-up period for this analysis. Linear regression models predicting standardized mobility, depressive symptoms, and IADLs, were adjusted for age, race, gender, birthplace, socio-economic status, and health at baseline. Results Compared to married individuals, recent widows had worse depressive symptoms (β = 0.71, 95% confidence interval (CI): [0.57, 0.85]). Near widows had worse depressive symptoms (β = 0.21, 95% CI: [0.08, 0.34]), mobility (β = 0.14, 95%CI: [0.01, 0.26]), and word recall (β = −0.13, 95%CI: [−0.23, −0.02]) compared to married individuals. Conclusions Health declines before spousal death suggests some portion of the “widowhood effect” may be attributable to experiences that precede widowhood and interventions prior to bereavement might help preserve the health of the surviving spouse.

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“…A proportion of the excess deaths due to cardiac 56 conditions in the early stages of bereavement may result from inadequate condition 57 management immediately prior to bereavement (Shah, Carey et al 2013), indicating that acute 58 stress at this stage contributes to the widowhood effect (Vable, Subramanian et al 2015). As 59 time since bereavement increases the mortality differential between widows and non-widows 60 tends to decrease for women in the first ten years but may increase subsequently, whereas men 61 are likely to show a sustained or increased mortality differential , 62 Berntsen, Kravdal 2012, .…”

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confidence: 99%