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• W3216589660 abstract "This article refers to ‘Death of a child and the risk of heart failure: a population-based cohort study from Denmark and Sweden’ by D. Wei et al., published in this issue on pages 181–189. Heart failure (HF) is a leading cause of cardiovascular morbidity and mortality.1 In developed countries, 1%–2% of the population suffers from HF, with a prevalence of ≥10% among people aged 70 years or older.2 Despite improvements in the medical management of HF, the prognosis of HF patients continues to remain unfavourable. The risks of developing HF include traditional atherosclerotic factors such as hypertension, diabetes mellitus, dyslipidaemia, some modern factors such as kidney and pulmonary diseases, sleep disordered breathing,3 and socioeconomic factors (e.g. education, income levels, and social isolation).4 Psychological factors, including mental stress, may also act as risk factors for HF.5 A bereavement of a close family member can be a distressing experience that may induce a tremendous amount of mental stress. In particular, the death of a child is presumed to be an extremely devastating event for parents. In this issue of the Journal, Wei and colleagues provide novel findings regarding the death of a child in relation to the risk of HF for the parents in a large-scale population-based cohort study, using medical records of the Danish and Swedish Medical Birth Registers.6 During a median follow-up of 22 years, 129 829 out of 6 717 349 participants (1.9%) who participated in the study lost at least one child. The incidence rate of HF was 113.4 per 105 person-years in the bereaved parents, while that in non-bereaved parents was 44.3. The multivariable incidence rate ratio (IRR) (95% confidence interval) was 1.35 (1.29–1.41, p < 0.001) in the bereaved parents. The association between the death of a child and HF was observed regardless of the cause of death (i.e. cardiovascular, other natural, and unnatural causes) with relatively high IRR for cardiovascular deaths. The association was U-shaped when the bereaved parents were categorized in relation to the number of remaining live children when the parents had loss (the lowest IRR for 1–2 live children) or by the age of the deceased child (the lowest IRR for ages from 13 to 18 years). Stronger associations were observed in mothers as opposed to fathers and younger parents (aged <50 years) than in older parents. The researchers' findings on the bereavement of a child as a risk factor for HF from large cohorts and the long follow-up time are notable. The underlying mechanisms linking bereavement to HF have been discussed previously.7 Compared to non-bereaved individuals, individuals exhibit a lower heart rate variability, higher heart rate, and higher systolic blood pressure through autonomic dysfunction, and hypercoagulability.8-10 These findings have direct clinical relevance, given that the haemodynamic changes and hypercoagulability are associated with a greater risk of cardiovascular disease, which can cause HF. The adverse effects of bereavement on cardiovascular disease may also be a result of unhealthy lifestyle behaviours including excessive alcohol intake, tobacco smoking, unhealthy diet, insufficient sleep hygiene, and inadequate physical activity11 – all of which are risk factors for cardiovascular disease. Furthermore, bereaved people are prone to reduce self-esteem and lose interest in themselves, leading to unfavourable health management of themselves, such as avoidance of medical care and poor adherence to medications for those under medical treatments.12 The abovementioned mechanisms are summarized in Figure 1. Wei and colleagues' study provides findings that may support these mechanisms. The researchers' study had limitations, some of which are acknowledged by themselves and should be considered when interpreting the findings of the study. First, the follow-up information on the health status relevant to HF is insufficient. Although there is a link between bereavement and causes of HF, such as coronary artery disease, hypertension, or cardiomyopathy, it may precede the development of HF and remain to be elucidated. Second, the researchers did not fully discuss the time from death of a child to the development of HF in bereaved individuals. Although the causality between bereavement and HF has not yet been established, bereavement might exert both short-term and long-term effects on the cardiovascular system. As stated in their limitations, stress-induced or Takotsubo cardiomyopathy can be one of the causes of HF since Takotsubo cardiomyopathy often presents itself with HF. Furthermore, substance abuse during grieving or drug overdose as an attempt to commit suicide shortly after bereavement may cause HF.13 Long-term effects of bereavement on HF could be mediated by unhealthy lifestyle behaviours.11 People who have experienced bereavement of their lover may not care for their health and may choose unhealthy behaviours as a way of self-abandonment. Similarly, bereaved people who have cardiovascular risks or cardiovascular diseases, including HF, may be reluctant to visit their physicians despite the need for medical care to prevent the development and recurrence of HF.12 Since Wei's study was conducted using databases from two high-income countries with highly developed healthcare and welfare systems, further studies in different countries with different socioeconomic statuses including low- or middle-income countries are warranted in order to capture the effects of bereavement of a child on the parents' health in terms of development of both communicable and non-communicable diseases. A growing body of literature demonstrates that healthcare providers recognize the need for bereavement support for parents who have lost their child and/or family member, resulting in a variety of bereavement interventions being reported.14-16 The interventions consisted of education and information on coping and grief, establishing keepsakes such as pictures or toys that belonged to the child, long-term follow-up contact or calls from the care providers, and remembrance activities such as ceremonies. However, no interventions specific to preventing cardiovascular diseases have been established. Overarching programmes that encompass the abovementioned variety of interventions are needed for bereaved parents to accept the reality of losing a loved one, cope with mental stress, refrain from unhealthy behaviours, and eventually maintain both their physical and mental health. Conflict of interest: R.N. is affiliated with a department endowed by Philips, ResMed, and Fukuda Denshi. T.K. has nothing to disclose." @default.
• W3216589660 created "2021-12-06" @default.
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• W3216589660 title "Bereavement of a child as a risk of heart failure" @default.
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• W3216589660 doi "https://doi.org/10.1002/ejhf.2388" @default.
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