Why the study?
Although bereavement is linked to cardiovascular morbidity and mortality, its association with prognosis after acute myocardial infarction has not been well documented.
Does bereavement increase the risk of recurrent AMI and ischemic heart disease death in patients after a first AMI?
Does bereavement increase the risk of recurrent AMI and ischemic heart disease death in patients after a first AMI?
Bereavement, particularly the loss of a partner, is associated with a slightly increased risk of recurrent AMI, ischemic heart disease death, total mortality, heart failure, and stroke after a first AMI.
Bereavement-associated risk of recurrent events post-AMI should not change practice; leaves open causal inference and intervention trials.
BACKGROUND Despite accumulating evidence suggesting that bereavement is associated with increased risks of cardiovascular morbidity and mortality, the association between bereavement and prognosis after acute myocardial infarction (AMI) has not been well documented. We investigated the association by using Swedish register data. METHODS AND RESULTS We studied 266 651 patients with a first AMI included in the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) quality register from 1991 to 2018. We obtained information on bereavement (ie, death of a partner, child, grandchild, sibling, or parent), on primary (nonfatal recurrent AMI and death attributed to ischemic heart disease) and secondary outcomes (total mortality, heart failure, and stroke) and on covariates from several national registers. The association was analyzed using Poisson regression. The bereaved patients had a slightly increased risk of the primary outcome; the corresponding risk ratio (RR) was 1.02 (95% CI, 1.00-1.04). An increased risk was noted any time bereavement occurred, except if the loss was in the year after the first AMI. The association was strongest for the loss of a partner, followed by the loss of a child, grandchild, sibling, or parent. We also observed increased risks for total mortality (RR, 1.14 [95% CI, 1.12-1.16]), heart failure (RR, 1.05 [95% CI, 1.02-1.08]), and stroke (RR, 1.09 [95% CI, 1.05-1.13]) following bereavement. CONCLUSIONS Bereavement was associated with an increased risk of poor prognosis after a first AMI. The association varied by the relationship to the deceased.
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Wei et al. (2022) studied this question.
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