Association of marital/partner status and patient-reported outcomes following myocardial infarction: a systematic review and meta-analysis

Abstract

Aims Little is known about the relationship between marital/partner status and patient-reported outcome measures (PROMs) following myocardial infarction (MI). We conducted a systematic review/meta-analysis and explored potential sex differences. Methods We searched five databases (Medline, Web of Science, Scopus, EMBASE, and PsycINFO) from inception to July 27, 2022. Peer-reviewed studies of MI patients that evaluated marital/partner status as an independent variable and reported its associations with defined PROMs were eligible for inclusion. Results for eligible studies were classified into 4 pre-specified outcome domains (health-related quality of life [HRQoL], functional status, symptoms, and personal recovery [i.e., self-efficacy, adherence, purpose/hope]). Study quality was appraised using Newcastle-Ottawa Scale and data were synthesized by outcome domains. We conducted subgroup analysis by sex. Results We included 34 studies (n=16,712), of which 11 were included in meta-analyses. Being married/partnered was significantly associated with higher HRQoL (six studies [n=2,734]; pooled standardized mean difference, 0.37 [95% CI, 0.12-0.63], I2=51%) but not depression (three studies [n=2,005]; pooled OR, 0.72 [95% CI, 0.32-1.64]; I2=65%) or self-efficacy (two studies [n=356]; pooled β, 0.03 [95% CI, -0.09-0.14]; I2=0%). The association of marital/partner status with functional, personal recovery outcomes, and symptoms of anxiety and fatigue were mixed. Sex differences were not evident due to mixed results from the available studies. Conclusions Married/Partnered MI patients had higher HRQoL than unpartnered patients, but the associations with functional, symptom, personal recovery outcomes, and sex differences were less clear. Our findings inform better methodological approaches and standardized reporting to facilitate future research on these relationships.