Living alone after myocardial infarction. Impact on prognosis
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Published on: January 28, 2020
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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