Comparisons of Patients Living Alone versus Living with Others in Acute Coronary Syndrome

Area of Science:

• Cardiology
• Public Health

Background:

• Living arrangements are increasingly recognized as a social determinant of health.
• Understanding the impact of social factors like living alone on acute coronary syndrome (ACS) outcomes is crucial for patient care.

Purpose of the Study:

• To investigate the association between living arrangements (alone vs. with others) and clinical characteristics, plaque morphology, and clinical outcomes in patients with ACS.
• To determine if living alone is an independent predictor of cardiac mortality in ACS patients.

Main Methods:

• Retrospective analysis of 1,683 consecutive ACS patients, comparing those living alone (n=318) with those living with others (n=1,362).
• Optical coherence tomography (OCT) was used to analyze culprit lesion plaque morphology in a subset of patients (n=174 living alone vs. n=665 living with others).
• Kaplan-Meier analysis and Cox proportional hazards models were used to assess 2-year cardiac mortality, adjusting for relevant covariates.

Main Results:

• Patients living alone were older and more frequently female, presented with more severe clinical symptoms (Killip II/III/IV), and had a lower frequency of timely admission (≤6 hours from onset).
• Plaque morphology assessed by OCT was similar between groups.
• Living alone was associated with a significantly higher rate of 2-year cardiac mortality (13.9% vs. 8.5%) and identified as an independent predictor after adjusting for confounders (HR 1.582, P=0.026).

Conclusions:

• Living alone is an independent risk factor for 2-year cardiac mortality in patients with acute coronary syndrome.
• The increased mortality risk associated with living alone appears unrelated to the underlying atherosclerosis or plaque morphology.
• These findings highlight the importance of considering social support systems in the management and follow-up of ACS patients.