Heart Vulnerable While Spouse Is in ICU

Having a spouse in the ICU was linked to modestly elevated risk of a cardiovascular event, a Japanese observational study showed.

Healthcare visits for cardiovascular diseases in the 4 weeks after the spouse's ICU admission were a relative 27% more common compared with control couples (2.7% vs 2.1%, OR 1.27, 95% CI 1.08-1.50), Hiroyuki Ohbe, MD, MPH, of the University of Tokyo School of Public Health, and colleagues reported in Circulation.

Hospitalization rates for such events were also elevated, albeit uncommon: 0.3% among those with a spouse in the ICU versus 0.2% among controls (OR 2.29, 95% CI 1.30-4.05) and 0.2% versus 0.1% for stroke, acute coronary syndrome, arrhythmia, congestive heart failure, or pulmonary embolism (OR 2.72, 95% CI 1.28-5.78).

The researchers pointed to increased psychological stress and altered behavioral health risk factors as likely causes, along with "the stress of decision-making and substantial caregiving burden."

Strategies to mitigate the risk might include not only a support infrastructure in the ICU for spouses, such as connecting them to bereavement groups, but also making sure they get seen as patients themselves, perhaps with blood pressure and EKG checks in primary care, commented Suzanne Steinbaum, DO, of the Heart and Vascular Institute at Lenox Hill Hospital in New York City and a spokesperson for the American Heart Association.

While the researchers cautioned that their study included only employed and insured individuals, Steinbaum noted that generalizability is likely.

"In fact, the Japanese were the first to identify takotsubo cardiomyopathy but we have certainly seen that in our population," she noted, and plenty of prior evidence points to heart and mortality risk with bereavement.

The findings are especially relevant for the many families affected by severe COVID-19 and may help explain some of the elevated general population mortality during the COVID-19 pandemic, Steinbaum suggested. A Cleveland Clinic study showed an uptick in stress cardiomyopathy among people who tested negative for SARS-CoV-2 during the pandemic.

"What we're really going to learn from COVID is there are people who didn't just die of COVID but because of COVID," she told MedPage Today. "There has probably been an increase in mortality and morbidity for the ones that were left behind. I'm fairly certain this study is shedding light on what we have been seeing and what we will understand at some point."

The study analyzed the Japan Medical Data Center database of outpatient and inpatient health insurance claims: 7,815 spouses of patients (mean age 54, 35% men) admitted to ICUs for more than 2 days matched with 31,250 couples without ICU exposure by age, sex, and medical insurance status. Events were defined by diagnoses with ICD-10 codes for cardiovascular diseases.

People with a spouse in the ICU were more likely to be diagnosed with hypertension (22% vs 20%), type 2 diabetes (18% vs 17%), and hyperlipidemia (23% vs 22%).

The results for hospitalization for cardiovascular diseases and severe cardiovascular events were comparable with those in the main analysis.

No significant differences were seen between groups in a control period 6 months prior to ICU admission or in multiple periods examined beyond the 4 weeks post-admission.

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