Intensive care unit (ICU) admission of a loved one puts acute psychological stress on the family members of the patient. Approximately 25% to 50% of the family members of a critically ill patient experience symptoms of posttraumatic stress, anxiety, and depression, which have been termed “postintensive care syndrome–family.”1,2 A previous bereavement study showed significant associations between the acute psychological stress experienced by family members after bereavement and increased risks of cardiovascular events.3 The ICU is a setting where death is common, and family members of patients with life-threatening conditions may be faced with decisions regarding whether to withhold or withdraw life-sustaining treatments. Therefore, acute psychological stress among family members of ICU patients may increase risk of cardiovascular diseases. In this context, using a large claims database in Japan, we tested the hypothesis that the ICU admission of a spouse is associated with greater risk of cardiovascular events in the short term after the spouse’s ICU admission.

Using data on married couples from the Japan Medical Data Center (JMDC) database, we conducted a matched-pair cohort study. This study was approved by the institutional review board of the University of Tokyo (approval number 10862-[1]). All data were deidentified, but family members could be combined using the family ID variable.

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