Effect of Living Alone on Patient Outcomes After Hospitalization for Acute Myocardial Infarction

Abstract

Considerable attention has been devoted to the effect of social support on patient outcomes after acute myocardial infarction (AMI). However, little is known about the relation between patient living arrangements and outcomes. Thus, we used data from PREMIER, a registry of patients hospitalized with AMI at 19 US centers between 2003-04, to assess the association of living alone with post-AMI outcomes. Outcome measures included 4-year mortality, 1-year readmission, and 1-year health status, using the Seattle Angina Questionnaire (SAQ) and Short Form-12 physical health component (SF-12 PCS) scales. Patients who lived alone had higher crude 4-year mortality (21.8% vs. 14.5%, P<0.001), but comparable rates of 1-year readmission (41.6% vs. 38.3%, p=0.79). Living alone was associated with lower unadjusted quality of life (mean SAQ −2.40 (95% confidence interval [CI] −4.44, −0.35), p=0.02), but had no impact on SF-12 PCS (−0.45 (95% CI −1.65, 0.76), p=0.47) compared with patients who did not live alone. After multivariable adjustment, patients who lived alone had a comparable risk of mortality (hazard ratio [HR] 1.35, 95% CI: 0.94-1.93) and readmission (HR 0.99, 95% CI: 0.76-1.28) as patients who lived with others. Mean quality of life scores remained lower among patients who lived alone (SAQ −2.91 (95% CI −5.56, −0.26), p=0.03). Living alone may be associated with poorer angina-related quality of life one year post-MI, but is not associated with mortality, readmission, or other health status measures after adjusting for other patient and treatment characteristics.

Relation of Patients Living Without a Partner or Spouse to Being Physically Active After Acute Coronary Syndromes (from the PULSE Accelerometry Substudy)

“…22 Similarly, an analysis of the PREMIER Registry showed a crude association between living alone and increased mortality 4 years after MI. 23 However, the association was no longer significant after adjustment for other patient and treatment characteristics including. 23 Finally, data from the REACH Registry showed an increased risk of death at 4 years among those living alone.…”

“…23 However, the association was no longer significant after adjustment for other patient and treatment characteristics including. 23 Finally, data from the REACH Registry showed an increased risk of death at 4 years among those living alone. 24 However, a significant interaction between age group and living alone was found such that living alone and mortality was not significant among participants older that 80 years of age.…”

Impact of Living Alone on the Care and Outcomes of Patients With Acute Stroke

“…8 Data from the 2011 Canadian census indicate that one quarter of the population ≥65 years old report living alone, and that women are nearly twice as likely to live alone than men (31.5% versus 16.0%). These data indicate that the negative impact of living alone on patients with stroke will be greater in women.…”

Predicting unplanned readmission after myocardial infarction from routinely collected administrative hospital data

“…Attempts to predict readmission after AMI have relied [24][25][26][27][28] are known to predict readmission after a coronary event, none is measured routinely in clinical practice at present and we do not know which biomarker or combination will yield the best prediction. There are several known clinical and demographic risk factors for readmission after AMI, [5][6][7][8]29 but their individual predictive power is relatively low and models derived from such factors have performed poorly. 4 Not surprisingly, the presence of comorbidities such as vascular disorders, hypertension, diabetes and other cardiorespiratory conditions increases the risk of readmission after AMI, and combining these into indices results in modest predictive power.…”

“…To date, reliable risk stratification of AMI patients admitted has proved challenging despite several well-documented risk factors, 4 including severe heart failure, 4 multivessel disease, 5 living alone, 6 ethnic background, 7 psychological comorbidities 8,9 and socioeconomic factors. 10 As with many clinical prediction problems, the known risk factors for readmission after AMI individually have only weak predictive ability.…”