Marital Status as an Independent Predictor of Event-Free Survival of Patients with Heart Failure

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 Back 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=.01). Conclusions: Patients with a spouse had longer event-free survival than nonmarried patients did, even in the context of depressive symptoms.