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Living alone after myocardial infarction. Impact on prognosis
1Department of Medicine, St. Luke's Roosevelt Hospital, New York, NY 10025.
Insights
Living alone increases the risk of major cardiac events after myocardial infarction. A disrupted marriage, however, does not independently affect cardiac event prognosis.
Area of Science:
- Cardiology
- Psychosocial Medicine
- Public Health
Background:
- Myocardial infarction (MI) survivors face risks of recurrent cardiac events.
- Prognostic factors for post-MI outcomes are crucial for patient management.
- The impact of social factors like marital status on cardiac prognosis requires further investigation.
Purpose of the Study:
- To investigate whether a disrupted marriage or living alone are independent prognostic risk factors for major cardiac events after an initial myocardial infarction.
Main Methods:
- Prospective evaluation within a randomized, double-blind drug trial (placebo arm).
- Cox proportional hazards model used to analyze data on living alone and marital disruption.
- Patients (N=1234) with confirmed acute myocardial infarction were followed for 1-4 years.
Main Results:
- Living alone emerged as an independent risk factor for recurrent major cardiac events (Hazard Ratio: 1.54, P < .03).
- Patients living alone had a 6-month recurrent cardiac event rate of 15.8% versus 8.8% for those not living alone.
- A disrupted marriage was not found to be an independent risk factor.
Conclusions:
- Living alone is a significant independent risk factor for prognosis following myocardial infarction.
- Marital disruption does not appear to be an independent predictor of cardiac events post-MI.
- These findings highlight the importance of social support systems in cardiac recovery.
Objective:
To determine if the presence of a disrupted marriage or living alone would be an independent prognostic risk factor for a subsequent major cardiac event following an initial myocardial infarction.
Design:
Prospective evaluation in the placebo wing of a randomized, double-blind drug trial in patients with an enzyme-documented acute myocardial infarction who were admitted to a coronary care facility. Data for living alone and/or a marital disruption were entered into a Cox proportional hazards model constructed from important physiologic and nonphysiologic factors in the same database.
Setting:
Multicenter trial in a mixture of community and academic hospitals in the United States and Canada.
Patients:
All consenting patients who were 25 to 75 years of age and without other serious diseases were enrolled (placebo, N = 1234) within 3 to 15 days of the index infarction and followed for a period of 1 to 4 years (mean, 2.1 years). Nine hundred sixty-seven patients were followed for 1.1 years and 530 for 2.2 years.
Primary Outcome Measure:
Recurrent major cardiac event (either recurrent nonfatal infarction or cardiac death).
Results:
Living alone was an independent risk factor, with a hazard ratio of 1.54 (95% confidence interval, 1.04 to 2.29; P less than .03). Using the Kaplan-Meier statistical method for calculation, the recurrent cardiac event rate at 6 months was 15.8% in the group living alone vs 8.8% in the group not living alone. Risk remained significant throughout the follow-up period (P = .001). A disrupted marriage was not an independent risk factor.
Conclusion:
Living alone but not a disrupted marriage is an independent risk factor for prognosis after myocardial infarction when compared with all other known risk factors.
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