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Zhu C, Dreyer RP, Li F, Spatz ES, Caraballo C, Mahajan S, Raparelli V, Leifheit EC, Lu Y, Krumholz HM, Spertus JA, D’Onofrio G, Pilote L, Lichtman JH. Association of marital/partner status with hospital readmission among young adults with acute myocardial infarction. PLoS One 2024; 19:e0287949. [PMID: 38277368 PMCID: PMC10817183 DOI: 10.1371/journal.pone.0287949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024] Open
Abstract
INTRODUCTION Despite evidence supporting the benefits of marriage on cardiovascular health, the impact of marital/partner status on the long-term readmission of young acute myocardial infarction (AMI) survivors is less clear. We examined the association between marital/partner status and 1-year all-cause readmission and explored sex differences among young AMI survivors. METHODS Data were from the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients), which enrolled young adults aged 18-55 years with AMI (2008-2012). The primary end point was all-cause readmission within 1 year of hospital discharge, obtained from medical records and patient interviews and adjudicated by a physician panel. We performed Cox proportional hazards models with sequential adjustment for demographic, socioeconomic, clinical, and psychosocial factors. Sex-marital/partner status interaction was also tested. RESULTS Of the 2,979 adults with AMI (2002 women [67.2%]; mean age 48 [interquartile range, 44-52] years), unpartnered individuals were more likely to experience all-cause readmissions compared with married/partnered individuals within the first year after hospital discharge (34.6% versus 27.2%, hazard ratio [HR] = 1.31; 95% confidence interval [CI], 1.15-1.49). The association attenuated but remained significant after adjustment for demographic and socioeconomic factors (adjusted HR, 1.16; 95% CI, 1.01-1.34), and it was not significant after further adjusting for clinical factors and psychosocial factors (adjusted HR, 1.10; 95%CI, 0.94-1.28). A sex-marital/partner status interaction was not significant (p = 0.69). Sensitivity analysis using data with multiple imputation and restricting outcomes to cardiac readmission yielded comparable results. CONCLUSIONS In a cohort of young adults aged 18-55 years, unpartnered status was associated with 1.3-fold increased risk of all-cause readmission within 1 year of AMI discharge. Further adjustment for demographic, socioeconomic, clinical, and psychosocial factors attenuated the association, suggesting that these factors may explain disparities in readmission between married/partnered versus unpartnered young adults. Whereas young women experienced more readmission compared to similar-aged men, the association between marital/partner status and 1-year readmission did not vary by sex.
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Affiliation(s)
- Cenjing Zhu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Rachel P. Dreyer
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
- Center for Methods in Implementation and Preventive Science, Yale University, New Haven, CT, United States of America
| | - Erica S. Spatz
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States of America
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States of America
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States of America
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Erica C. Leifheit
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States of America
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States of America
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States of America
| | - John A. Spertus
- Healthcare Institute for Innovations in Quality, University of Missouri–Kansas City, Kansas City, Missouri, United States of America
- Saint Luke’s Cardiovascular Outcomes Research, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, United States of America
| | - Gail D’Onofrio
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Louise Pilote
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Judith H. Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
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Shibata Y, Kobayashi N, Shirakabe A, Miyauchi Y, Asai K. Comparisons of Patients Living Alone versus Living with Others in Acute Coronary Syndrome. Int J Angiol 2023; 32:179-187. [PMID: 37576535 PMCID: PMC10421695 DOI: 10.1055/s-0043-1767697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
We aimed to examine the relationship of living arrangements (i.e., living alone or living with others) with background, clinical severity, preintervention culprit lesion plaque morphology, and clinical outcomes in patients with acute coronary syndrome (ACS). Among 1,683 consecutive patients with ACS, we retrospectively compared patients living alone ( n = 318) versus living with others ( n = 1,362). Optical coherence tomography (OCT) findings, which are high-resolution intracoronary imaging devices, were analyzed in patients with preintervention OCT and compared between patients living alone ( n = 174) versus those living with others ( n = 665). Older (median; 69 vs. 67 y, p = 0.046) and female (31 vs. 17%, p < 0.001) patients more frequently lived alone. Frequency of achieving a time interval of 6 hours or less from ACS onset to admission was lower in patients living alone (56 vs. 63%, p = 0.022). Clinical presentation was more severe in patients living alone (Killip II/III/IV; 27 vs. 22%, p = 0.029). Plaque morphology evaluated by OCT was similar between groups (plaque rapture; 48 vs. 48%, p = 0.171). Kaplan-Meier analyses revealed higher rates of cardiac mortality during 2-year follow-up period in patients living alone [13.9 vs. 8.5%, hazard ratio (HR) 1.604, 95% confidence interval (CI) 1.112-2.313, p = 0.010]. After traditional cardiovascular risk factors and clinical severity upon admission had been adjusted, living alone was an independent predictor of cardiac mortality in ACS patients (HR 1.582, 95% CI 1.056-2.371, p = 0.026). Living alone was independently associated with 2-year cardiacmortality in ACS patients after adjusting for background and presentation and might be unrelated to the development of atherosclerosis.
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Affiliation(s)
- Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Nobuaki Kobayashi
- Cardiovascular Center, Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yasushi Miyauchi
- Cardiovascular Center, Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kuniya Asai
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
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Marcus G, Kofman N, Maymon SL, Asher E, Loberman D, Pereg D, Fuchs S, Minha S. Marital status impact on the outcomes of patients admitted for acute decompensation of heart failure: A retrospective, single-center, analysis. Clin Cardiol 2023; 46:914-921. [PMID: 37309080 PMCID: PMC10436802 DOI: 10.1002/clc.24053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/07/2023] [Accepted: 05/13/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Conflicting evidence exists regarding the association between marital status and outcomes in patients with heart failure (HF). Further, it is not clear whether type of unmarried status (never married, divorced, or widowed) disparities exist in this context. HYPOTHESIS We hypothesized that marital status will be associated with better outcomes in patients with HF. METHODS This single-center retrospective study utilized a cohort of 7457 patients admitted with acute decompensated HF (ADHF) between 2007 and 2017. We compared baseline characteristics, clinical indices, and outcomes of these patients grouped by their marital status. Cox regression analysis was used to explore the independency of the association between marital status and long-term outcomes. RESULTS Married patients accounted for 52% of the population while 37%, 9%, and 2% were widowed, divorced, and never married, respectively. Unmarried patients were older (79.8 ± 11.5 vs. 74.8 ± 11.1 years; p < 0.001), more frequently women (71.4% vs. 33.2%; p < 0.001), and less likely to have traditional cardiovascular comorbidities. Compared with married patients, all-cause mortality incidence was higher in unmarried patients at 30 days (14.7% vs. 11.1%, p < 0.001), 1 year, and 5 years (72.9% vs. 68.4%, p < 0.001). Nonadjusted Kaplan-Meier estimates for 5-year all-cause mortality by sex, demonstrated the best prognosis for married women, and by marital status in unmarried patients, the best prognosis was demonstrated in divorced patients while the worst was recorded in widowed patients. After adjustment for covariates, marital status was not found to be independently associated with ADHF outcomes. CONCLUSIONS Marital status is not independently associated with outcomes of patients admitted for ADHF. Efforts for outcomes improvement should focus on other, more traditional risk factors.
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Affiliation(s)
- Gil Marcus
- Cardiology, Shamir Medical CenterBe'er‐YaakovIsrael
- Sackler School of MedicineTel‐Aviv UniversityRamat‐AvivIsrael
| | - Natalia Kofman
- Cardiology, Shamir Medical CenterBe'er‐YaakovIsrael
- Sackler School of MedicineTel‐Aviv UniversityRamat‐AvivIsrael
| | - Shiri L. Maymon
- Sackler School of MedicineTel‐Aviv UniversityRamat‐AvivIsrael
| | - Elad Asher
- The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of MedicineHebrew UniversityJerusalemIsrael
| | - Dan Loberman
- Cape Cod Hospital, Brigham and Women's Hospital, Harvard Medical SchoolDivision of Cardiac SurgeryBostonMassachusettsUSA
| | - David Pereg
- Sackler School of MedicineTel‐Aviv UniversityRamat‐AvivIsrael
- Cardiology DepartmentMeir Medical CenterKfar‐SabaIsrael
| | - Shmuel Fuchs
- Cardiology, Shamir Medical CenterBe'er‐YaakovIsrael
- Sackler School of MedicineTel‐Aviv UniversityRamat‐AvivIsrael
| | - Sa'ar Minha
- Cardiology, Shamir Medical CenterBe'er‐YaakovIsrael
- Sackler School of MedicineTel‐Aviv UniversityRamat‐AvivIsrael
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Zhu C, Dreyer RP, Li F, Spatz ES, Caraballo C, Mahajan S, Raparelli V, Leifheit EC, Lu Y, Krumholz HM, Spertus JA, D’Onofrio G, Pilote L, Lichtman JH. Association of Marital/Partner Status with Hospital Readmission Among Young Adults With Acute Myocardial Infarction. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.20.23291664. [PMID: 37425864 PMCID: PMC10327186 DOI: 10.1101/2023.06.20.23291664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Introduction Despite evidence supporting the benefits of marriage on cardiovascular health, the impact of marital/partner status on the long-term readmission of young acute myocardial infarction (AMI) survivors is less clear. We aimed to examine the association between marital/partner status and 1-year all-cause readmission, and explore sex differences, among young AMI survivors. Methods Data were from the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients), which enrolled young adults aged 18-55 years with AMI (2008-2012). The primary end point was all-cause readmission within 1 year of hospital discharge, obtained from medical record, patient interviews, and adjudicated by a physician panel. We performed Cox proportional hazards models with sequential adjustment for demographic, socioeconomic, clinical and psychosocial factors. Sex-marital/partner status interaction was also tested. Results Of the 2,979 adults with AMI (2002 women [67.2%]; mean age 48 [interquartile range, 44-52] years), unpartnered individuals were more likely to experience all-cause readmissions compared with married/partnered individuals within the first year after hospital discharge (34.6% versus 27.2%, hazard ratio [HR]=1.31; 95% confidence interval [CI], 1.15-1.49). The association attenuated but remained significant after adjustment for demographic and socioeconomic factors (adjusted HR, 1.16; 95%CI, 1.01-1.34), and was not significant after further adjusting for clinical factors and psychosocial factors (adjusted HR, 1.10; 95%CI, 0.94-1.28). Sex-marital/partner status interaction was not significant (p=0.69). Sensitivity analysis using data with multiple imputation, and restricting outcomes to cardiac readmission yielded comparable results. Conclusions In a cohort of young adults aged 18-55 years, unpartnered status was associated with 1.3-fold increased risk of all-cause readmission within 1 year of AMI discharge. Further adjustment for demographic, socioeconomic, clinical and psychosocial factors attenuated the association, suggesting that these factors may explain disparities in readmission between married/partnered versus unpartnered young adults. Whereas young women experienced more readmission compared to similar-aged men, the association between marital/partner status and 1-year readmission did not vary by sex.
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Affiliation(s)
- Cenjing Zhu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Rachel P Dreyer
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Center for Methods in Implementation and Preventive Science, Yale University, New Haven, CT, USA
| | - Erica S Spatz
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Erica C Leifheit
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA
- Department of Cardiology, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - John A Spertus
- Healthcare Institute for Innovations in Quality, University of Missouri – Kansas City, Missouri, USA
- Saint Luke’s Cardiovascular Outcomes Research, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
| | - Gail D’Onofrio
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Louise Pilote
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Rasmussen AN, Guise A, Overgaard C. The role of social support in the experience of life with ischemic heart disease for socially disadvantaged patients: A qualitative study. Chronic Illn 2023; 19:354-367. [PMID: 34870487 DOI: 10.1177/17423953211065005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Ischemic heart disease (IHD) displays wide social inequalities that are often explained with reference to lifestyle factors. However, research indicates that social support may also play an important role in social inequality in IHD. This study aims to explore the role of social support in the experience of life with IHD for socially disadvantaged patients. METHODS The study was conducted as a critical hermeneutic qualitative study in Denmark between October 2018 and August 2019. Data consist of in-depth qualitative interviews with 30 socially disadvantaged patients with IHD. RESULTS The findings showed a notable difference between the participants who were engaged in close and supportive social relationships and those who were not. Life with IHD for those who lacked supportive relationships tended to be marked by feelings of chaos, powerlessness and meaninglessness. Contrarily, those who were engaged in supportive relationships received help to navigate their life with illness, reconcile with what had happened to them, feel empowered, and gain a sense of meaning in their life.Discussion: Social support from close social relationships appears to be crucial for socially disadvantaged ischemic heart patients, and should be encouraged and facilitated in healthcare and interventions targeting this patient group.
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Affiliation(s)
- Amanda Nikolajew Rasmussen
- Department of Health Science and Technology, 1004Aalborg University, Niels Jernes Vej 14, 9220 Aalborg Øst, Denmark
| | - Andrew Guise
- Population Health Sciences, 4616King's College London, Great Maze Pond, London SE1 1UL, UK
| | - Charlotte Overgaard
- Department of Health Science and Technology, 1004Aalborg University, Niels Jernes Vej 14, 9220 Aalborg Øst, Denmark
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Jamalian M, Roohafza H, Soleimani A, Massoumi G, Mirmohammadsadeghi A, Dorostkar N, Yazdekhasti S, Azarm M, Sadeghi M. Predictors of Mortality for Patients with ST-Elevation Myocardial Infraction after 2-Year Follow-Up: A ST-Elevation Myocardial Infarction Cohort in Isfahan Study. Adv Biomed Res 2022; 11:116. [PMID: 36798920 PMCID: PMC9926029 DOI: 10.4103/abr.abr_242_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022] Open
Abstract
Background Mortality of ST-elevation myocardial infarction (STEMI) patients is increasing in world. This study defines predictors of mortality in patients who have STEMI. Materials and Methods This study was a part of the ST-elevated myocardial infarction cohort study in Isfahan conducted on 876 acute myocardial infarction (MI) followed for 2 years that 781 patient entered. The effect of predictors of mortality includes demographic, physiological, and clinical characterizes compared in two groups alive and died patients. MACE was defined as nonfatal MI, nonfatal stroke, and atherosclerosis cardiovascular disease-related death was recorded. Univariate and multiple logistic regression analyses were performed. All analyses performed using SPSS 20.0. P < 0.05 considered statistically significant. Results A total 781 patients, 117 (13%) that 72 (8.5%) was in-hospital died. The mean (standard deviation) age of the patients was 60.92 (12.77) years and 705 (81.3%) patients were males. Significant factors that affected mortality on analysis of demographic and physiological parameters were age (P < 0.001), sex (P = 0.004), transfusion (P = 0.010), STEMI type (P < 0.001), number epicardial territories >50% (P = 0.001), ventilation options (P < 0.001), smoker (P = 0.003), and diabetes (P = 0.026). Significant clinical factors affected mortality were ejection fraction (EF) (P < 0.001), creatinine (P < 0.001), hemoglobin (P < 0.001), low-density lipoprotein-cholesterol (LDL-C) (P = 0.019), and systolic blood pressure (P < 0.001). Multiple logistics regression model definition significant predictors for mortality were age (P < 0.001), heart rate (HR) (P = 0.007), EF (0.039), LDL-C (P = 0.002), and preangia (P = 0.022). Conclusion The set of factors can increase or decrease mortality in these patients. Significant predictors of mortality STEMI patients by 2-year follow up were age, HR, EF, LDL-C, and preangia. It seems that more articles need to be done in different parts of Iran to confirm the results.
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Affiliation(s)
- Marjan Jamalian
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Soleimani
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Massoumi
- Department of Anesthesiology, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhossein Mirmohammadsadeghi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Dorostkar
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Safoura Yazdekhasti
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maedeh Azarm
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Masoumeh Sadeghi, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Wei Z, Yang J, Qian H, Yang Y. Impact of Marital Status on Management and Outcomes of Patients With Acute Myocardial Infarction: Insights From the China Acute Myocardial Infarction Registry. J Am Heart Assoc 2022; 11:e025671. [PMID: 36444834 PMCID: PMC9851450 DOI: 10.1161/jaha.122.025671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Acute myocardial infarction (AMI) is one of the leading causes of mortality worldwide, whereas social support is a known predictor of the prognosis after AMI. As a common factor influencing social support, the impact of marital status on care quality, in-hospital mortality, and long-term prognosis of patients with AMI remains largely unknown. Methods and Results The present study analyzed data from the CAMI (China Acute Myocardial Infarction) registry involving 19 912 patients with AMI admitted at 108 hospitals in China between January 2013 and September 2014 and aimed to evaluate marital status-based differences in acute management, medical therapies, and short-term and long-term outcomes. The primary end point was 2-year all-cause death. The secondary end points included in-hospital death and 2-year major adverse cardiac and cerebrovascular events (a composite of all-cause death, myocardial infarction, or stroke). After multivariable adjustment, 1210 (6.1%) unmarried patients received less reperfusion treatment in patients with both ST-segment-elevation myocardial infarction and non-ST-segment-elevation myocardial infarction (adjusted odds ratio [OR], 0.520 [95% CI, 0.437-0.618]; P<0.0001; adjusted OR, 0.489 [95% CI, 0.364-0.656]; P<0.0001). Being unmarried was not associated with poorer in-hospital outcome but with long-term all-cause mortality and major adverse cardiac and cerebrovascular events in both ST-segment-elevation myocardial infarction (adjusted hazard ratio [HR], 1.225 [95% CI, 1.031-1.456]; P=0.0209; adjusted HR, 1.277 [95% CI, 1.089-1.498]; P=0.0027) and non-ST-segment-elevation myocardial infarction (adjusted HR, 1.302 [95% CI, 1.036-1.638]; P=0.0239; adjusted HR, 1.368 [95% CI, 1.105-1.694]; P=0.0040) populations. Conclusions The present study suggests that being unmarried is independently related to less reperfusion received, but could not explain the higher in-hospital mortality rate after covariate adjustment. Being unmarried is associated with a substantially increased risk of adverse events over at least the first 24 months after AMI. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01874691.
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Affiliation(s)
- Zhi‐Yao Wei
- Department of Cardiology, Center for Coronary Heart Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jin‐Gang Yang
- Department of Cardiology, Center for Coronary Heart Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hai‐Yan Qian
- Department of Cardiology, Center for Coronary Heart Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yue‐Jin Yang
- Department of Cardiology, Center for Coronary Heart Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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The Association between Marital Status and Outcomes of Patients Hospitalized with Heart Failure. Int J Behav Med 2022:10.1007/s12529-022-10117-2. [PMID: 35943708 DOI: 10.1007/s12529-022-10117-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Little is known about the association between marital status and long-term outcomes of patients hospitalized with heart failure (HF). We aimed to examine the association between marital status and early as well as long-term outcomes of patients hospitalized with HF. METHOD We analyzed data of 4089 patients hospitalized with HF and were enrolled in the multicenter national survey in Israel between March and April 2003 and were followed until December 2014. Patients were classified into married (N = 2462, 60%) and unmarried (N = 1627, 40%). RESULTS Married patients were more likely to be males, younger, and more likely to have past myocardial infarction and previous revascularization. Also, they tended to have higher rates of diabetes mellitus (DM) and dyslipidemia, as well as smokers. Survival analysis showed that unmarried patients had higher mortality rates at 1 and 10 years (33% vs. 25%, at 1 year, 89% vs. 80% at 10 years, all p < 0.001). Consistently, multivariable analysis showed that unmarried patients had independently 44% and 35% higher risk of mortality at 1- and 10-year follow-up respectively (1-year HR = 1.44; 95%CI 1.14-1.81; p = 0.002, 10-year HR = 1.35; 95%CI 1.19-1.53; p ≤ 0.001). Other consistent predictors of mortality at both 1- and 10-year follow-up include age, renal failure, and advanced HF. CONCLUSIONS Being unmarried is independently associated with worse short- and long-term outcomes, particularly among women. Thus, attempts to intensify secondary preventive measures should focus mainly on unmarried patients and mainly women.
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Deng Q, Long Y, Guo M, Wang M, Sun J, Lu F, Chang J, Su Y, Hu P, Zhao D, Liu J. Overall and gender-specific associations between marital status and out-of-hospital coronary death during acute coronary events: a cross-sectional study based on data linkage in Beijing, China. BMJ Open 2022; 12:e059893. [PMID: 35450912 PMCID: PMC9024228 DOI: 10.1136/bmjopen-2021-059893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess overall and gender-specific associations between marital status and out-of-hospital coronary death (OHCD) compared with patients surviving to hospital admission. DESIGN A cross-sectional study based on linkage of administrative health databases. SETTING Beijing, China. PARTICIPANTS From 2007 to 2019, 378 883 patients with acute coronary event were identified in the Beijing Monitoring System for Cardiovascular Diseases, a validated city-wide registration system based on individual linkage of vital registration and hospital discharge data. OUTCOME MEASURES OHCD was defined as coronary death occurring before admission. Multilevel modified Poisson regression models were used to calculate the prevalence ratios (PR) and 95% CIs. RESULTS Among 378 883 acute coronary events, OHCD accounted for 33.8%, with a higher proportion in women compared with men (41.5% vs 28.7%, p<0.001). Not being married was associated with a higher proportion of OHCD in both genders, with a stronger association in women (PR 2.18, 95% CI 2.10 to 2.26) than in men (PR 1.97, 95% CI 1.91 to 2.02; p for interaction <0.001). The associations of OHCD with never being married (PR 1.98, 95% CI 1.88 to 2.08) and being divorced (PR 2.54, 95% CI 2.42 to 2.67) were stronger in men than in women (never married: PR 0.98, 95% CI 0.82 to 1.16; divorced: PR 1.47, 95% CI 1.34 to 1.61) (p for interaction <0.001 for both). Being widowed was associated with a higher proportion of OHCD in both genders, with a stronger association in women (PR 2.26, 95% CI 2.17 to 2.35) compared with men (PR 1.89, 95% CI 1.84 to 1.95) (p for interaction <0.001). CONCLUSIONS Not being married was independently associated with a higher proportion of OHCD and the associations differed by gender. Our study may aid the development of gender-specific public health interventions in high-risk populations characterised by marital status to reduce OHCD burden.
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Affiliation(s)
- Qiuju Deng
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Ying Long
- School of Architecture, Tsinghua University, Beijing, China
| | - Moning Guo
- Beijing Municipal Health Big Data and Policy Research Center, Beijing Institute of Hospital Management, Beijing, China
| | - Miao Wang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Jiayi Sun
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Feng Lu
- Beijing Municipal Health Big Data and Policy Research Center, Beijing Institute of Hospital Management, Beijing, China
| | - Jie Chang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yuwei Su
- School of Architecture, Tsinghua University, Beijing, China
| | - Piaopiao Hu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Jing Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
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Takagi H, Hari Y, Nakashima K, Kuno T, Ando T. Marriage and mortality after acute coronary syndrome. Eur J Prev Cardiol 2019; 27:2374-2384. [PMID: 31690097 DOI: 10.1177/2047487319881832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Japan
| | - Yosuke Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Japan
| | - Kouki Nakashima
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Japan
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, USA
| | - Tomo Ando
- Division of Interventional Cardiology, New York Presbyterian Hospital/Columbia University Medical Center, USA
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11
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Marcus G, Litovchik I, Pereg D, Beigel R, Sholmo N, Iakobishvili Z, Goldenberg I, Fuchs S, Minha S. Impact of Marital Status on the Outcome of Acute Coronary Syndrome: Results From the Acute Coronary Syndrome Israeli Survey. J Am Heart Assoc 2019; 8:e011664. [PMID: 31266391 PMCID: PMC6662115 DOI: 10.1161/jaha.118.011664] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Marriage is one of the common forms of social support. Conflicting evidence exists about the impact of marital status on the outcomes of patients with acute coronary syndrome (ACS). It is further not clear if sex disparity exists in the outcome of married and nonmarried patients with ACS. Methods and Results Data from the ACS Israeli Survey, collected between 2004 and 2016, were used to compare baseline characteristics, clinical indexes, and outcomes of married and nonmarried patients with ACS. Cox regression analysis and propensity score matching were used to explore if marital status was independently associated with long‐term outcome. Of 7233 patients included with reported marital status, 5643 (78%) were married. Married patients were younger (62.69±12.07 versus 68.47±14.84 years; P<0.001), more frequently men (83.1% versus 54.8%; P<0.001), and less likely to be hypertensive (61.1% versus 69.3%; P<0.001). All‐cause mortality incidence at 30 days and at 1 year was lower in married patients (3.1% versus 7.6% [P<0.001]; and 7.1% versus 15.3% [P<0.001], respectively). After adjusting for multiple covariates, the hazard ratio for 5‐year all‐cause mortality for married patients was 0.74 (95% CI, 0.62–0.88). Similar results were observed after propensity score matching. Kaplan‐Meier estimates for all‐cause mortality at 5 years demonstrated the best prognosis for married men and the worst for nonmarried women. Conclusions Marriage is independently associated with better short‐ and long‐term outcomes across the spectrum of ACS. Attempts to intensify secondary prevention measures should focus on nonmarried patients and especially nonmarried women.
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Affiliation(s)
- Gil Marcus
- 1 Department of Cardiology Assaf-Harofeh Medical Center Zerifin Israel.,2 Sackler School of Medicine Tel-Aviv University Ramat-Aviv Israel
| | - Ilya Litovchik
- 1 Department of Cardiology Assaf-Harofeh Medical Center Zerifin Israel.,2 Sackler School of Medicine Tel-Aviv University Ramat-Aviv Israel
| | - David Pereg
- 2 Sackler School of Medicine Tel-Aviv University Ramat-Aviv Israel.,3 Department of Cardiology Meir Medical Center Kfar Saba Israel
| | - Roy Beigel
- 2 Sackler School of Medicine Tel-Aviv University Ramat-Aviv Israel.,4 Leviev Heart Center Sheba Medical Center Tel Hashomer Ramat Gan Israel
| | - Nir Sholmo
- 2 Sackler School of Medicine Tel-Aviv University Ramat-Aviv Israel.,4 Leviev Heart Center Sheba Medical Center Tel Hashomer Ramat Gan Israel
| | - Zaza Iakobishvili
- 2 Sackler School of Medicine Tel-Aviv University Ramat-Aviv Israel.,5 Department of Community Cardiology Clalit Health Services Tel-Aviv District Israel
| | - Ilan Goldenberg
- 2 Sackler School of Medicine Tel-Aviv University Ramat-Aviv Israel.,4 Leviev Heart Center Sheba Medical Center Tel Hashomer Ramat Gan Israel
| | - Shmuel Fuchs
- 1 Department of Cardiology Assaf-Harofeh Medical Center Zerifin Israel.,2 Sackler School of Medicine Tel-Aviv University Ramat-Aviv Israel
| | - Sa'ar Minha
- 1 Department of Cardiology Assaf-Harofeh Medical Center Zerifin Israel.,2 Sackler School of Medicine Tel-Aviv University Ramat-Aviv Israel
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