Living Alone, Patient Sex and Mortality After Acute Myocardial Infarction

Abstract

BACKGROUND: Psychosocial factors, including social support, affect outcomes of cardiovascular disease, but can be difficult to measure. Whether these factors have different effects on mortality post-acute myocardial infarction (AMI) in men and women is not clear. OBJECTIVE:To examine the association between living alone, a proxy for social support, and mortality postdischarge AMI and to explore whether this association is modified by patient sex.DESIGN: Historical cohort study. PARTICIPANTS/SETTING:All patients discharged with a primary diagnosis of AMI in a major urban center during the 1998-1999 fiscal year. MEASUREMENTS:Patients' sociodemographic and clinical characteristics were obtained by standardized chart review and linked to vital statistics data through December 2001. RESULTS:Of 880 patients, 164 (18.6%) were living alone at admission and they were significantly more likely to be older and female than those living with others. Living alone was independently associated with mortality [adjusted hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.0-2.5], but interacted with patient sex. Men living alone had the highest mortality risk (adjusted HR 2.0, 95% CI 1.1-3.7), followed by women living alone (adjusted HR 1.2, 95% CI 0.7-2.2), men living with others (reference, HR 1.0), and women living with others (adjusted HR 0.9, 95% CI 0.5-1.5). CONCLUSIONS:Living alone, an easily measured psychosocial factor, is associated with significantly increased longer-term mortality for men following AMI. Further prospective studies are needed to confirm the usefulness of living alone as a prognostic factor and to identify the potentially modifiable mechanisms underlying this increased risk.

The Male Partners' Experiences of the Intimate Relationships after a First Myocardial Infarction

“…Moreover, living alone could play a part as a predictor of increased risk for long-term mortality in patients suffering from MI. This is especially significant for male patients, but even women living alone have a higher risk compared to women living in a relationship [8].…”

Marital status and outcomes after myocardial infarction: Observations from the Canadian Observational Antiplatelet Study (COAPT)

“…Beyond marital status, we do not have sufficient detail to further describe patients' social support where added care-provider networks may exist. 30,31,35 Considering followup, 15 months may not be sufficient time to observe significant effects of marital status on CV risk following MI, with other reports noting significant effects at 3 years among patients with CVD and 10 years among patients with hyperlipidemia, respectively. 9,10 Moreover, we did not account for recurrent CV events in our analysis, and this may underestimate the total burden of MI and stroke.…”

“…In married vs unmarried men and women, past studies highlighted differences in outcomes following an MI. 21,24,25,[29][30][31] It was observed that women receive less informal caregiver support than do men, with worse outcomes, 1 to 12 months following an MI. 25 However, in contrast with many of the prior studies that controlled simply for certain socioeconomic determinants of health, such as income and education, we additionally adjusted for differences in baseline comorbidities that may have attenuated any association with marital status.…”

Role of biological and non biological factors in congestive heart failure mortality: PREDICE-SCORE: A clinical prediction rule

“…In fact, social aspects are given scant consideration in the trials as possible predictive factors of mortality [32,33] and rehospitalization [34,35].…”