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Loneliness, Social Isolation, and Living Alone Associations With Mortality Risk in Individuals Living With Cardiovascular Disease: A Systematic Review, Meta-Analysis, and Meta-Regression. Psychosom Med 2023; 85:8-17. [PMID: 36441849 DOI: 10.1097/psy.0000000000001151] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to conduct a systematic review and meta-analysis of associations between loneliness, social isolation, and living alone and risk of mortality among individuals with established cardiovascular disease. METHODS Five electronic databases were searched (MEDLINE [Ovid], PsycINFO, EMBASE, PubMed, and SCOPUS) from inception to November 25, 2021. In all, 35 studies were included in a narrative synthesis and, where appropriate, a meta-analytic evaluation using a random-effects model. RESULTS Living alone was associated with increased risk of all-cause mortality ( k = 15, n = 80,243, hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.20-1.83, I2 = 83%), and meta-regressions found that the effects were stronger in studies from Europe and with longer follow-up. However, there was evidence of publication bias. Social isolation was associated with increased risk of all-cause mortality, measured both as a dichotomous variable ( k = 3, n = 2648, HR = 1.46, 95% CI = 1.08-2.04, I2 = 31%) and as a continuous variable ( k = 5, n = 2388, HR = 1.11, 95% CI = 1.02-1.24, I2 = 51%). Meta-analysis was not feasible for loneliness as exposure, but narrative synthesis of four studies suggested a tentative association between loneliness and increased risk of all-cause mortality. CONCLUSIONS Supporting public health concerns, our review finds that loneliness, social isolation, and living alone are associated with premature mortality among individuals with established cardiovascular disease. However, evidence of publication bias and large methodological differences across studies point to the need for more rigorous research.
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Lee SW, Han B, Cho SJ, Jung SJ, Huh Y, Kim J, Eum DH, Kim T, Min SH, Lee W, Cho J, Kwon MH, Nam GE. Associations between Living Alone and Smoking and Alcohol Consumption in Korean Adults. Korean J Fam Med 2020; 41:306-311. [PMID: 32450678 PMCID: PMC7509128 DOI: 10.4082/kjfm.18.0148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/03/2019] [Indexed: 11/29/2022] Open
Abstract
Background Recently, single-person households have increased in Korea and this trend may have potential public health implications and affect various health behaviors. This study investigated the associations between living alone and health behaviors such as smoking and alcohol consumption among Korean adults. Methods We used data from the 6th Korea National Health and Nutrition Examination Survey between 2013 and 2015 and a total of 17,088 adults were included. We performed a multivariable logistic regression analysis and calculated odds ratios (ORs) with 95% confidence intervals (CIs). Results Single-person households accounted for about 10% of the total participants. The proportions of currently smoking and heavy alcohol consumption were higher among individuals living alone than those living together among younger women and middle-aged and elderly men and women. In the multivariable logistic regression analysis, living alone was associated with increased odds of currently smoking compared to living together among middle-aged men and women (OR, 7.37; 95% CI, 2.33–23.32 in men and OR, 2.36; 95% CI, 1.04–5.36 in women) after adjusting for confounding variables. Conclusion From this nationwide, population-based study, we found that living alone is associated with increased odds of currently smoking, especially in middle-aged people. Public health concerns may be warranted for middle-aged single-person households to reduce health risks related to smoking.
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Affiliation(s)
- Sang-Woo Lee
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Byoungduck Han
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Sung Jung Cho
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Seung Jin Jung
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Youn Huh
- Department of Family Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Junghun Kim
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Do Hyun Eum
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Taeryoon Kim
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Soon-Hong Min
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Woohyun Lee
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Jinhee Cho
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Min Hee Kwon
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Ga Eun Nam
- Department of Family Medicine, Sahmyook Medical Center, Seoul, Korea.,Department of Family Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Laursen UB, Johansen MB, Joensen AM, Lau CJ, Overvad K, Larsen ML. Educational level and living arrangements are associated with dietary intake of red meat and fruit/vegetables: A Danish cross-sectional study. Scand J Public Health 2019; 47:557-564. [PMID: 30632902 DOI: 10.1177/1403494818821482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: To evaluate the association between education and living arrangements and the intake of fish, red meat and fruit and vegetables.Methods: The study design was cross-sectional and conducted in Denmark in 2013. Participants filled in questionnaires about their educational level and living arrangements (living alone or with others) and dietary intake including fish, red meat, fruit and vegetables. Regression analyses were performed to assess the associations within 85,456 randomly sampled healthy men and women who were at least 25 years old.Results: Length of education was statistically significant and positively associated with the intake of fruit and vegetables and negatively associated with the intake of red meat for both men and women. Men with a high level of education had a 187g/week (95% confidence interval: 199-175g/week) lower intake of red meat and a 109g/day (95% confidence interval: 102-117g/day) higher intake of fruit and vegetables than men with a low level of education. Women with a high level of education had a 175g/week (95% confidence interval: 186-164g/week) lower intake of red meat and a 106g/day (95% confidence interval: 97-114g/day) higher intake of fruit and vegetables than women with a low level of education. Living with others was statistically significant and positively associated with the intake of red meat, and fruit and vegetables. There were no clear associations between education, living arrangements and intake of fish.Conclusions: Men and women with a high educational level ate more fruit and vegetables but less red meat than men and women with a low educational level. Men and women living with others ate more red meat, fruit and vegetables than men and women living alone.
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Affiliation(s)
| | | | | | - Cathrine Juel Lau
- 3 Research Centre for Prevention and Health, Rigshospitalet - Glostrup University Hospital, Denmark
| | - Kim Overvad
- 1 Department of Cardiology, Aalborg University Hospital, Denmark.,4 Department of Public Health, Aarhus University, Denmark
| | - Mogens Lytken Larsen
- 1 Department of Cardiology, Aalborg University Hospital, Denmark.,5 Danish Centre against Inequality in Health (DACUS), Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Tsutsui T, Tanaka H, Nishida A, Asukai N. Posttraumatic stress symptoms as predictive of prognosis after acute coronary syndrome. Gen Hosp Psychiatry 2017; 45:56-61. [PMID: 28274340 DOI: 10.1016/j.genhosppsych.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/17/2016] [Accepted: 11/22/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Takumi Tsutsui
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Department of Psychiatry, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Niigata University Graduate School of Medical and Dental sciences, Niigata, Japan.
| | - Hiroyuki Tanaka
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Atsushi Nishida
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Nozomu Asukai
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Veromaa V, Kautiainen H, Saxen U, Malmberg-Ceder K, Bergman E, Korhonen PE. Ideal cardiovascular health and psychosocial risk factors among Finnish female municipal workers. Scand J Public Health 2016; 45:50-56. [DOI: 10.1177/1403494816677661] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aims: Ideal cardiovascular health has been defined by the American Heart Association as the absence of disease and the presence of seven key health factors and behaviours. However, little is known about the mental aspects associated with ideal cardiovascular health metrics. The objective of this study was to assess the relationships between psychosocial risk factors and ideal cardiovascular health metrics among Finnish women at municipal work units. Method: A cross-sectional study was conducted in Finland among 732 female employees (mean±SD age 48±10 years) from ten work units in 2014. Ideal cardiovascular health metrics were evaluated with a physical examination, laboratory tests, medical history and self-administrated questionnaires. Psychosocial risk factors (social isolation, stress, depressive symptoms, anxiety, hostility and type D personality) were assessed with core questions as suggested by the European Society of Cardiology. Results: The prevalence of having 5–7 ideal cardiovascular health metrics was 183 (25.0%), of whom 54.1% had at least one psychosocial risk factor. Anxiety (31.3%), work stress (30.7%) and type D personality (26.1%) were the most prevalent of the psychosocial risk factors. The prevalence of depressive symptoms ( p<0.001) and type D personality ( p=0.049) decreased linearly according to the sum of ideal cardiovascular health metrics after adjustment for age and years of education. Conclusions: Even women with good cardiovascular health are affected by psychosocial risk factors at municipal work units. Although the association is possibly bidirectional, screening and treating depression and dealing with type D personality might be crucial in improving cardiovascular health among women.
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Affiliation(s)
- Veera Veromaa
- Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Finland
- Central Satakunta Health Federation of Municipalities, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, FinlandÕ) Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Ulla Saxen
- Department of Psychiatry, Hospital District of Satakunta, Finland
| | - Kirsi Malmberg-Ceder
- Institute of Clinical Medicine, Department of Neurology, University of Turku and Turku, University Hospital, Finland
| | - Elina Bergman
- Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Finland
| | - Päivi E. Korhonen
- Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Finland
- Central Satakunta Health Federation of Municipalities, Finland
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Estimating the incidence of the acute coronary syndrome: data from a Danish cohort of 138290 persons. ACTA ACUST UNITED AC 2016; 14:608-14. [DOI: 10.1097/hjr.0b013e328278522f] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Estimates of incidence are crucial to the planning of public health measures, but most studies of incidence of, for example, acute myocardial infarction (MI) are troubled by methodological problems such as; (i) selection biases of the patients being included for study, (ii) lack of identification and control of the cohort under observation, (iii) inconsistencies in the use of diagnostic criteria, and (iv) missing data. We aimed to measure directly the incidence of the entire spectrum of the acute coronary syndrome (ACS), consisting of unstable angina pectoris, MI and sudden cardiac death (SCD), by use of the new criteria for MI as proposed in 2000. Design Cohort study. Methods From a cohort of 138 290 residents of the municipality of Aarhus, Denmark, aged 30-69 years, with a demographic structure known at the individual population member level, we prospectively identified all consecutive ACS patients from 1 April 2000 to 31 March 2002. The population was identified from Danish Population Registers. Results A total of 189 victims of SCD and 457 ACS patients who survived until admission to hospital were present. Consequently, crude incidence rate of ACS was 234 per 100000 person-years. Unstable angina pectoris constituted for 16.9%, MI for 53.8% and SCD for 29.3% of ACS patients. Conclusions Crude incidence rates of ACS were 137 and 331 per 100 000 person years for women and men, respectively. The incidence rate of ACS, as measured directly, was insignificantly 6% higher than expected from Danish administrative databases. Eur J Cardiovasc Prev Rehabil 14:608-614 © 2007 The European Society of Cardiology
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Nielsen KM, Larsen ML, Foldspang A, Faergeman O. Living alone and atypical clinical presentation are associated with higher mortality in patients with all components of the acute coronary syndrome. ACTA ACUST UNITED AC 2016; 14:152-4. [PMID: 17301642 DOI: 10.1097/01.hjr.0000238399.35094.3e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Most prognostic studies of the acute coronary syndrome (ACS) have been performed in patients selected for inclusion into clinical trials. We stratified the risk of death during the year after hospitalization for a first episode of ACS in unselected patients based on clinical and socio-economic information. METHODS In 2000-2002 we identified 457 consecutive unselected patients admitted to hospital with a first episode of ACS. Vital status was obtained from Danish national registers. RESULTS The 1-year case-fatality proportion was 9.8%. Positive predictors of mortality were living alone, Q waves and diabetes. Negative predictors were chest pain, ST elevation and treatment with angioplasty or thrombolysis.
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Affiliation(s)
- Kirsten M Nielsen
- Department of Internal Medicine and Cardiology, Aarhus Sygehus University Hospital, Aarhus, Denmark.
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Living arrangements as determinants of myocardial infarction incidence and survival: A prospective register study of over 300,000 Finnish men and women. Soc Sci Med 2015; 133:93-100. [DOI: 10.1016/j.socscimed.2015.03.054] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ong MEH, Wah W, Hsu LY, Ng YY, Leong BSH, Goh ES, Gan HN, Tham LP, Charles RA, Foo DCG, Earnest A. Geographic factors are associated with increased risk for out-of hospital cardiac arrests and provision of bystander cardio-pulmonary resuscitation in Singapore. Resuscitation 2014; 85:1153-60. [DOI: 10.1016/j.resuscitation.2014.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/07/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
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Comparison of long-term mortality after acute myocardial infarction treated by percutaneous coronary intervention in patients living alone versus not living alone at the time of hospitalization. Am J Cardiol 2014; 114:522-7. [PMID: 24998090 DOI: 10.1016/j.amjcard.2014.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/15/2014] [Accepted: 05/15/2014] [Indexed: 11/20/2022]
Abstract
Living alone was reported to be associated with increased risk of cardiovascular disease. There are, however, limited data on the relation between living alone and all-cause mortality in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). The Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) AMI registry was a cohort study of patients with AMI enrolled in 26 hospitals in Japan from 2005 through 2007. For the current analysis, we included those patients who underwent PCI within 24 hours of symptom onset, and we assessed their living status to determine if living alone would be an independent prognostic risk factor. Among 4,109 patients eligible for the current analysis of 5,429 patients enrolled in the CREDO-Kyoto AMI registry, 515 patients (12.5%) were living alone at the time of hospital admission. The cumulative 5-year incidence of all-cause death was 18.3% in the living alone group and 20.1% in the not living alone group (log-rank p = 0.77). After adjusting for potential confounders, risk of the living alone group relative to the not living alone group for all-cause death was not significantly different (adjusted hazard ratio 0.82, 95% confidence interval 0.65 to 1.02, p = 0.08). In a subgroup analysis stratified by age, the adjusted risk for all-cause death was also not different between the living alone group and the not living alone group both in the older population (aged ≥75 years) and the younger population (aged <75 years). In conclusion, living alone was not associated with higher long-term mortality in patients with AMI who underwent PCI.
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11
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Long-term prognostic significance of living alone and other risk factors in patients with acute myocardial infarction. Ir J Med Sci 2014; 184:153-8. [DOI: 10.1007/s11845-014-1079-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
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Lammintausta A, Airaksinen JKE, Immonen-Räihä P, Torppa J, Kesäniemi AY, Ketonen M, Koukkunen H, Kärjä-Koskenkari P, Lehto S, Salomaa V. Prognosis of acute coronary events is worse in patients living alone: the FINAMI myocardial infarction register. Eur J Prev Cardiol 2013; 21:989-96. [DOI: 10.1177/2047487313475893] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 01/07/2013] [Indexed: 01/21/2023]
Affiliation(s)
| | | | | | - Jorma Torppa
- National Institute for Health and Welfare, Helsinki, Finland
| | | | | | - Heli Koukkunen
- University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Kuopio, Finland
| | | | | | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
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Meillier LK, Nielsen KM, Larsen FB, Larsen ML. Socially differentiated cardiac rehabilitation: can we improve referral, attendance and adherence among patients with first myocardial infarction? Scand J Public Health 2012; 40:286-93. [PMID: 22637368 DOI: 10.1177/1403494812443600] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM The comprehensive cardiac rehabilitation (CR) programme after myocardial infarction (MI) improves quality of life and results in reduced cardiac mortality and recurrence of MI. Hospitals worldwide face problems with low participation rates in rehabilitation programmes. Inequality in recruitment and participation among low educated and socially vulnerable patients must be addressed to lower inequality in post-MI health. Our aim was to improve referral, attendance, and adherence rates among socially vulnerable patients by systematic screening and by offering a socially differentiated cardiac rehabilitation programme. METHODS From 1 September 2002 to 31 December 2005, 388 first-incidence MI patients ≤75 years were hospitalised. Register check for newly hospitalised MI patients, screening interview, and systematic referral were conducted by a project nurse. Patients were referred to a standard rehabilitation programme (SRP). If patients were identified as socially vulnerable, they were offered an extended version of the rehabilitation programme (ERP). Excluded patients were offered home visits by a cardiac nurse. Concordance principles were used in the individualised programme elements. Adherence was registered until the 1-year follow up. RESULTS 86% were referred to the CR. A large share of elderly patients and women were excluded. The attendance and adherence rates were 80% and 71%, respectively among all hospitalised patients. Among referred patients, the attendance rate was 93%. Patients were equally distributed to the SRP and the ERP. No inequality was found in attendance and adherence among referred patients. CONCLUSIONS It seems possible to overcome unequal referral, attendance, and adherence in cardiac rehabilitation by organisation of systematic screening and social differentiation.
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Affiliation(s)
- Lucette Kirsten Meillier
- Health Promotion and Prevention, Centre of Public Health, Central Denmark Region, Aarhus, Denmark.
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Hadi Khafaji HAR, Al Habib K, Asaad N, Singh R, Hersi A, Al Falaeh H, Al Saif S, Al-Motarreb A, Almahmeed W, Sulaiman K, Amin H, Al-Lawati J, Al-Sagheer NQ, Alsheikh-Ali AA, Al Suwaidi J. Marital status and outcome of patients presenting with acute coronary syndrome: an observational report. Clin Cardiol 2012; 35:741-8. [PMID: 22740441 DOI: 10.1002/clc.22034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/17/2012] [Indexed: 12/18/2022] Open
Abstract
UNLABELLED BACKGROUND & HYPOTHESIS: Data on the clinical characteristics and outcome of patients presenting with acute coronary syndrome (ACS) according to their marital status is not clear. METHODS A total of 5334 patients presenting with ACS in 65 hospitals in 6 Middle East countries in the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2) were studied according to their marital status (5024 married, 100 single, and 210 widowed patients). RESULT When compared to married patients, widowed patients were older and more likely to be female. Widowed patients were more likely to have diabetes mellitus, hypertension, history of heart failure, and peripheral vascular disease and were less likely to be tobacco users when compared to the other groups. Widowed patients were also more likely to present with atypical symptoms and have advanced Killip class. Widowed patients were more likely to present with non-ST-elevation myocardial infarction (NSTEMI) when compared to the other 2 groups. Widowed patients were more likely to have heart failure (P = 0.001), cardiogenic shock (P = 0.001), and major bleeding (P = 0.002) when compared to the other groups. No statistically significant difference was observed in regard to duration of hospital stay, door to needle time in STEMI patients, or cardiac arrhythmias between the various groups. Widowed patients had higher in-hospital, 30-day, and 1-year mortality rates (P = 0.001). Marital status was an independent predictor for in-hospital mortality. CONCLUSION Widowed marital status was associated with worse cardiovascular risk profile, and worse in-hospital and 1-year outcome. Future work should be focused on whether the provision of psychosocial support will result in improved outcomes among this high-risk group.
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Affiliation(s)
- Hadi A R Hadi Khafaji
- Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Effect of living alone on patient outcomes after hospitalization for acute myocardial infarction. Am J Cardiol 2011; 108:943-8. [PMID: 21798499 DOI: 10.1016/j.amjcard.2011.05.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 05/12/2011] [Accepted: 05/12/2011] [Indexed: 11/24/2022]
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 United States centers from 2003 through 2004, to assess the association of living alone with outcomes after AMI. Outcome measurements included 4-year mortality, 1-year readmission, and 1-year health status using the Seattle Angina Questionnaire (SAQ) and the Short Form-12 Physical Health Component 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 to -0.35, p = 0.02) but had no impact on Short Form-12 Physical Health Component (-0.45, 95% CI -1.65 to 0.76, p = 0.47) compared to patients who did not live alone. After multivariable adjustment, patients who lived alone had a comparable risk of mortality (hazard ratio 1.35, 95% CI 0.94 to 1.93) and readmission (hazard ratio 0.99, 95% CI 0.76 to 1.28) as patients who lived with others. Mean quality-of-life scores remained lower in patients who lived alone (SAQ -2.91, 95% CI -5.56 to -0.26, p = 0.03). In conclusion, living alone may be associated with poorer angina-related quality of life 1 year after MI but is not associated with mortality, readmission, or other health status measurements after adjusting for other patient and treatment characteristics.
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Nielsen FE, Mard S. Single-living is associated with increased risk of long-term mortality among employed patients with acute myocardial infarction. Clin Epidemiol 2010; 2:91-8. [PMID: 20865108 PMCID: PMC2943193 DOI: 10.2147/clep.s8975] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE There is conflicting evidence about the impact of social support on adverse outcome after acute myocardial infarction (MI). We examined the relation between single-living and long-term all-cause mortality after MI. DESIGN A prospective cohort study of 242 employed patients with MI followed up to 16 years after MI. RESULTS A total of 106 (43.8%) patients died during the follow-up. Single-living nearly doubled the risk of death; after adjusting for potential confounding factors, single-living was an independent predictor of death, with a hazard ratio of 2.55 (95% confidence interval: 1.52-4.30). Other predictors of death were diabetes mellitus, atrial fibrillation, age, and ejection fraction less than 35%. CONCLUSION Single-living is a prognostic determinant of long-term all-cause mortality after MI.
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Nielsen KM, Faergeman O, Foldspang A, Larsen ML. Cardiac rehabilitation: health characteristics and socio-economic status among those who do not attend. Eur J Public Health 2008; 18:479-83. [PMID: 18614608 DOI: 10.1093/eurpub/ckn060] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is well documented, in randomised trials, to reduce mortality risk after myocardial infarction (MI). Selection of healthy patients for CR is a relatively unexplored problem. Our aims were to identify predictors of CR-attendance and to describe the prognosis as concerns mortality, re-admission and invasive treatment among CR-attendees as compared to CR-non-attendees. METHODS From a cohort of 138 290 persons aged 30-69 years, we identified consecutive MI patients, between 1 April 2000 and 31 March 2002. There were 206 MI patients, who survived until admission, and among the 200 who survived 30 days, 145 (72.5%) attended a comprehensive CR programme. Data were obtained from patient charts and from Danish population registers, and as a result we had no non-participation for the study. RESULTS The 2-year mortality proportions for patients surviving the first 30 days of admission were 2.8 and 21.8% among CR-attendees and CR-non-attendees, respectively (P < 0.0001). Among CR-non-attendees, there was a smaller fraction having an invasive treatment performed as compared with CR-attendees. By multiple logistic regression controlling for age and sex, CR-attendance was associated with chest pain, whereas CR-non-attendance was associated with low gross income, single living and inverted T-wave in the electrocardiogram. CONCLUSION CR attendance rate was 72.5%. Non-attendees have a higher mortality risk, which in part may be attributed to selection of healthy patients. Non-attendees are older and more likely to have atypical symptoms at admission, a low socioeconomic status and to live alone. Special attention is needed to improve CR attendance among such patients.
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Affiliation(s)
- Kirsten M Nielsen
- Department of Internal Medicine and Cardiology, Aarhus Sygehus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, Denmark.
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Giugliano RP, Braunwald E. The Year in Non–ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol 2007; 50:1386-95. [PMID: 17903640 DOI: 10.1016/j.jacc.2007.05.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 05/14/2007] [Indexed: 12/19/2022]
Affiliation(s)
- Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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