Family Research Laboratory

Co-Directors: Varda Shoham & Michael Rohrbaugh

Arizona Family Heart Project (AzFHP)
American Heart Association (AHA) Grant # 0051286Z
Principal Investigator:	Michael J. Rohrbaugh, Ph.D. Department of Psychology University of Arizona
Co- Investigator:	Varda Shoham, Ph.D. Department of Psychology University of Arizona
Co-Investigators:	Gordon Ewy, M.D. Director, Sarver Heart Center College of Medicine University of Arizona

Summary and Progress Report

Recent evidence suggests that psychosocial factors such as self-efficacy, psychological distress, perceived social support, and marital quality have prognostic significance for morbidity and mortality following heart failure (HF). In 2001 we reported findings from the Michigan Family Heart Project (Coyne, Rohrbaugh, Shoham, et al., 2001, pdf), indicating that interview and observational measures of marital quality obtained from 189 HF patients (139 men and 50 women) and their spouses predicted all-cause patient mortality over the next 4 years, independent of baseline illness severity (New York Heart Association [NYHA] class). In 2006 ( pdf ) we presented further follow-up results for this sample, with Cox regression analyses showing that a couple-level composite measure of marital quality continued to predict survival over an 8-year period (see Figure 1 below), especially when the patient was female (see Figure 2 below), and did so substantially better than individual (patient-level) risk and protective factors such as psychological distress, hostility, neuroticism, self-efficacy, optimism, and breadth of perceived emotional support. Relationship factors may be especially relevant in managing a difficult chronic condition like HF, which makes stringent and complex demands on patients and their families.

The Arizona Family Heart Project (AzFHP; Rohrbaugh, Shoham, and Ewy) was designed to explore how marital processes influence adaptation to CHF (and the patient’s ultimate survival). Participants were 60 couples in which one partner had CHF. The longitudinal design included home interviews with patients and spouses (T1); daily-diary reports starting six weeks later (T2); and follow-up interviews and medical record review at 6 months (T3). The study has been replicated by colleagues in Spain and Germany. Data collection in all sites are now complete and we are in the process of data analyses and report writing.

Figure 1. Patient survival for sub-groups formed by crossing high/low marital quality (MAR) and high/low HF severity (NYHA class): Hi MAR, NYHA I/II (n = 58), Hi MAR, NYHA III/IV (n = 38), Lo MAR, NYHA I/II (n = 50), Lo MAR, NYHA III/IV (n = 43). Cox regression shows significant main effects for both marital quality and NYHA class (p < .001), and the two predictors do not interact (Rohrbaugh, Shoham, & Coyne, 2006).

Figure 2. Patient survival for sub-groups formed by crossing high/low marital quality (MQ) and patient gender: High MQ female (n = 36), high MQ male (n = 60), low MQ female (n = 36), low MQ male (n = 60). Cox regression shows significant main effects for marital quality (p < .001), patient gender (p = .009), and the MQ x gender interaction (p =.01; Rohrbaugh, Shoham, & Coyne, 2006).