FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2021619703> ?p ?o ?g. }

• W2021619703 endingPage "948" @default.
• W2021619703 startingPage "943" @default.
• W2021619703 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. 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. Considerable attention has been devoted to the effect of social support and living arrangements on patient outcomes after acute myocardial infarction (AMI). Although living alone has been associated with an increased risk of acute coronary syndrome in the general population, the relation between living alone and outcomes after AMI is not well understood.1Nielsen K.M. Faergeman O. Larsen M.L. Foldspang A. Danish singles have a twofold risk of acute coronary syndrome: data from a cohort of 138 290 persons.J Epidemiol Community Health. 2006; 60: 721-728Crossref PubMed Scopus (20) Google Scholar Although some studies have found a positive association between living alone and mortality after AMI,2Case R.B. Moss A.J. Case N. McDermott M. Eberly S. Living alone after myocardial infarction Impact on prognosis.JAMA. 1992; 267: 515-519Crossref PubMed Scopus (404) Google Scholar others have not.3O'Shea J.C. Wilcox R.G. Skene A.M. Stebbins A.L. Granger C.B. Armstrong P.W. Bode C. Ardissino D. Emanuelsson H. Aylward P.E. White H.D. Sadowski Z. Topol E.J. Califf R.M. Ohman E.M. Comparison of outcomes of patients with myocardial infarction when living alone versus those not living alone.Am J Cardiol. 2002; 90: 1374-1377Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Furthermore, no studies have examined the impact of living alone on quality of life or functional status after AMI. The purpose of this study was to characterize the relation between living alone and outcomes after AMI including mortality, rehospitalization, and health status. We used data from the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER), a national prospective registry of patients hospitalized with AMI. Registry procedures and baseline data have been previously published.4Spertus J.A. Peterson E. Rumsfeld J.S. Jones P.G. Decker C. Krumholz H. Cardiovascular Outcomes Research ConsortiumThe Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER)—evaluating the impact of myocardial infarction on patient outcomes.Am Heart J. 2006; 151: 589-597Abstract Full Text Full Text PDF PubMed Scopus (109) Google Scholar In brief, PREMIER enrolled 2,498 patients with MI from 19 United States centers from January 1, 2003 through June 28, 2004. To be eligible patients had to be ≥18 years of age, have an AMI confirmed by cardiac enzymes, and show supporting signs or symptoms of AMI in the form of prolonged ischemia or electrocardiographic ST-segment elevation changes. For these analyses, patients with missing information on living alone were also excluded (n = 53) as were patients who were not discharged to hospice, nursing facilities, acute care, nonacute hospitals, or had expired (n = 181). Information on patient demographics, clinical presentation, and treatment were obtained from detailed chart abstractions and baseline interviews administered during the index hospitalization. As part of the interview, patients were asked about their living arrangements at home and categorized as living alone or with others. Patients also completed the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Social Support Instrument (ESSI), a 7-item self-report survey that assesses 4 domains of social support: emotional, instrumental, informational, and appraisal.5The ENRICHD investigatorsEnhancing recovery in coronary heart disease patients (ENRICHD): study design and methods.Am Heart J. 2000; 139: 1-9Abstract Full Text Full Text PDF PubMed Scopus (255) Google Scholar Outcome measurements included 4-year and 1-year mortalities, 1-year readmission, and 1-year changes in health status. Data on mortality was obtained through linkage of the Social Security Death Master File to patient identifiers including Social Security Number, name, and date of birth. Changes in health status were measured using the Seattle Angina Questionnaire (SAQ) and the Short Form-12 (SF-12). The SAQ is a 19-item self-administered questionnaire that assesses several domains of coronary artery disease on a scale of 0 to 100 including physical limitation, angina stability, angina frequency, treatment satisfaction, and angina-related quality of life.6Spertus J.A. Winder J.A. Dewhurst T.A. Deyo R.A. Prodzinski J. McDonell M. Fihn S.D. Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease.J Am Coll Cardiol. 1995; 25: 333-341Abstract Full Text PDF PubMed Scopus (1010) Google Scholar For this study, we focused on the quality-of-life component as an outcome. Unlike the SAQ, which measures disease-specific health status, the SF-12 evaluates general health status using Physical and Mental Component Scales.7Ware Jr, J. Kosinski M. Keller S.D. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity.Med Care. 1996; 34: 220-233Crossref PubMed Scopus (12376) Google Scholar For the 2 scales, lower numbers indicate worse health status. We compared baseline characteristics of patients who lived alone to those living with others using chi-square or Fisher's exact tests for categorical variables and t tests for continuous variables. To evaluate the independent association of living alone with mortality, rehospitalization, and health status measurements, we used Cox proportional hazards regression and linear regression models to adjust for patient and clinical characteristics. Covariates for multivariable analyses were selected using a combination of clinical judgment and examining the association between these factors and living-alone status. Covariates included patient demographics (age, gender, race, body mass index, marital status, employment status, living location, pet ownership, medical care payer, usual source of care, financial barriers to health care use), medical history (hypertension, depression, previous AMI, chronic heart failure), clinical presentation and treatment (left ventricular systolic function, creatinine, receipt of angiotensin-converting enzyme inhibitor and β blockers at discharge), ESSI score, and baseline health status scores. Of the 2,264 patients with living arrangement data in our sample, 471 patients (20.8%) reported living alone. A larger percentage of patients who lived alone were women and unemployed compared to patients who lived with others (Table 1). Patients living alone also tended to be older, to score lower on the ESSI, and to present with lower mean quality-of-life and physical functioning scores. The 2 groups were comparable in other clinical characteristics and treatment variables.Table 1Patient and clinical characteristics of sampleVariableLiving Alonep ValueYes (n = 471)No (n = 1,793)Age (years), mean ± SD62.7 ± 13.559.3 ± 12.3<0.001Women200 (42.5%)523 (29.2%)<0.001Race0.004 White321 (68.3%)1,354 (75.9%) Black129 (27.4%)344 (19.3%) Hispanic12 (2.6%)43 (2.4%) Asian2 (0.4%)5 (0.3%) Other6 (1.3%)37 (2.1%)Marital status<0.001 Married51 (11.0%)1,301 (73.0%) Divorced145 (31.2%)162 (9.1%) Separated31 (6.7%)51 (2.9%) Widowed145 (31.2%)113 (6.3%) Single (never married)8 (18.1%)126 (7.1%) Common law6 (1.3%)23 (1.3%) Other3 (0.6%)5 (0.3%)Employment status<0.001 Full time130 (27.7%)713 (40.1%) Part time39 (8.3%)150 (8.4%) Unemployed301 (64.0%)916 (51.5%)Living location<0.001 Owned home229 (48.8%)1,351 (76.2%) Owned home or apartment199 (42.4%)264 (14.9%) Relative or friend's home19 (4.1%)140 (7.9%) Nursing home or assisted living7 (1.5%)3 (0.2%) Homeless5 (1.1%)4 (0.2%) Other10 (2.1%)11 (0.6%)Pet ownership146 (31.1%)896 (50.1%)<0.001Medical care payer<0.001 Commercial/preferred provider organization136 (30.2%)789 (45.8%) Health maintenance organization50 (11.1%)225 (13.1%) Medicare155 (34.4%)334 (19.4%) Medicaid32 (7.1%)93 (5.4%) None/self-pay54 (12.0%)214 (12.4%)Other24 (5.3%)67 (3.9%)Usual source of care0.002 None57 (12.2%)191 (10.8%) Private doctor's office211 (45.0%)869 (49.0%) Health maintenance organization or prepaid health plan30 (6.4%)139 (7.8%) Neighborhood clinic27 (5.8%)167 (9.4%) Hospital outpatient clinic121 (25.8%)358 (20.2%) Hospital emergency room14 (3.0%)21 (1.2%) Other7 (1.5%)25 (1.4%)Avoided acquiring health care because of cost108 (23.3%)304 (17.2%)0.003Body mass index (kg/m2)<0.001 <18.511 (2.5%)20 (1.2%) 18.5–25139 (31.7%)351 (20.5%) 25–30147 (33.5%)629 (36.7%) 30–3587 (19.8%)437 (25.5%) 35–4041 (9.3%)165 (9.6%) >4014 (3.2%)110 (6.4%)Smoker293 (62.2%)491 (27.4%)0.918Alcohol use0.248 Never161 (71.6%)691 (71.3%) Less than monthly34 (15.1%)140 (14.4%) Monthly15 (6.7%)64 (6.6%) Weekly6 (2.7%)53 (5.5%) Daily9 (4.0%)21 (2.2%)Diabetes mellitus139 (29.5%)491 (27.4%)0.359Hypertension321 (68.2%)1,100 (61.3%)0.007Hypercholesterolemia220 (46.7%)908 (50.6%)0.129Congestive heart failure59 (12.5%)181 (10.1%)0.127Peripheral arterial disease34 (7.2%)127 (7.1%)0.919Previous myocardial infarction115 (24.4%)360 (20.1%)0.040Medication or counseling for depression78 (16.7%)207 (11.6%)0.004Clinical presentation and treatment Myocardial infarction diagnosis0.586 ST-elevation myocardial infarction199 (42.3%)801 (44.7%) Non–ST-elevation myocardial infarction270 (57.3%)980 (54.7%) Bundle-branch block/uncertain2 (0.4%)12 (0.7%) Killip class<0.001 I328 (79.0%)1,301 (86.4%) II73 (17.6%)152 (10.1%) III9 (2.2%)30 (2.0%) IV5 (1.2%)23 (1.5%) Left ventricular systolic dysfunction0.287 Normal239 (50.7%)971 (54.3%) Mild99 (21.0%)390 (21.8%) Moderate82 (17.4%)263 (14.7%) Severe51 (10.8%)165 (9.2%) Creatinine (mg/dl), mean ± SD1.5 ± 1.91.4 ± 1.50.048 Aspirin at arrival447 (97.4%)1,694 (96.6%)0.386 β Blocker at arrival396 (92.7%)1,507 (91.7%)0.469 Angiotensin-converting enzyme inhibitor for left ventricular systolic dysfunction at discharge105 (89.0%)313 (80.3%)0.030 β Blocker at discharge418 (94.6%)1,576 (91.6%)0.036Baseline health status and social support measurements ESSI score, mean ± SD20.4 (5.6%)22.7 (4.0%)<0.001 Seattle Angina Questionnaire quality of life, mean ± SD59.7 (24.4%)62.5 (23.2%)0.022 Short Form-12 Physical Component Scale score, mean ± SD40.0 (12.9%)44.0 (12.2%)<0.001 Short Form-12 Mental Component Scale score, mean ± SD49.2 (12.4%)49.7 (11.4%)0.479All baseline characteristics were collected from detailed chart abstractions and baseline interviews administered within 24 to 72 hours of the index admission. Unless otherwise noted, data are reported as number of patients (percentage). Open table in a new tab All baseline characteristics were collected from detailed chart abstractions and baseline interviews administered within 24 to 72 hours of the index admission. Unless otherwise noted, data are reported as number of patients (percentage). Patients who lived alone had higher unadjusted 1-year and 4-year mortalities but similar rates of 30-day mortality and 1-year readmission as patients who lived with others (Table 2). Living alone was also associated with lower unadjusted quality of life adjusted for baseline scores and mental functioning but had no association with physical functioning compared to patients who did not live alone (Table 3).Table 2Kaplan–Meier mortality and rehospitalizationClinical OutcomeLiving Alone (n = 471)Not Living Alone (n = 1,793)p Value30-day mortality6 (1.3%)19 (1.1%)0.6971-year mortality37 (7.9%)96 (5.4%)0.0394-year mortality102 (21.8%)256 (14.5%)<0.0011-year readmission161 (41.6%)606 (38.3%)0.792Data on mortality were collected through linkage to the Social Security Death Master File, whereas data on readmission were collected by self-report. Data are reported as number of patients (percentage). Open table in a new tab Table 3Unadjusted one-year health status measurementsHealth Status MeasurementLiving Alone (n = 471)Not Living Alone (n = 1,793)Difference (living alone vs not living alone)p ValueMean (95% CI)Seattle Angina Questionnaire quality-of-life score, mean ± SE82.1 ± 1.184.5 ± 0.8−2.4 (−4.4 to −0.4)0.022Short Form-12 Physical Component Scale score, mean ± SE44.4 ± 0.744.8 ± 0.5−0.4 (−1.7 to 0.8)0.4676Short Form-12 Mental Component Scale score, mean ± SE52.0 ± 0.653.8 ± 0.4−1.7 (−2.8 to −0.7)0.0011Health status measurements included the Seattle Angina Questionnaire quality-of-life and Short Form-12 Physical and Mental Component Scale scores collected at baseline and at 1 year. Data are reported as mean health status measurements at 1 year adjusted for baseline measurements. Open table in a new tab Data on mortality were collected through linkage to the Social Security Death Master File, whereas data on readmission were collected by self-report. Data are reported as number of patients (percentage). Health status measurements included the Seattle Angina Questionnaire quality-of-life and Short Form-12 Physical and Mental Component Scale scores collected at baseline and at 1 year. Data are reported as mean health status measurements at 1 year adjusted for baseline measurements. After adjustment for patient and clinical characteristics, there were no significant differences in mortality between those living alone and those living with others (4-year mortality hazard ratio 1.35, 95% confidence interval [CI] 0.94 to 1.93; Table 4). Mean quality-of-life scores remained slightly lower in patients who lived alone (SAQ −2.87, 95% CI −5.52 to −0.22, p = 0.03), whereas mean mental and physical functioning scores were comparable between groups (SF-12 Mental Component Scale −0.90, 95% CI −2.32 to 0.53, p = 0.22; SF-12 Physical Component Scale 1.04, 95% CI −0.58 to 2.66, p = 0.21; Table 5). Other variables associated with increased mortality and rehospitalization included female gender, living in a nursing home or assisted-living facility, hypertension, congestive heart failure, and presenting with an increased creatinine level (Table 6). In contrast, homelessness, difficulty obtaining medical care, and receipt of depression medication or counseling were associated with worse health status measurements at 1 year.Table 4Unadjusted and adjusted mortality and rehospitalizationClinical OutcomeUnadjustedAdjustedp ValueNot Living AloneLiving AloneNot Living AloneLiving AloneHR (referent)HR (95% CI)HR (referent)HR (95% CI)1-year mortality1.001.49 (1.02, 2.18)1.000.95 (0.52, 1.74)0.8694-year mortality1.001.56 (1.24, 1.96)1.001.35 (0.94, 1.93)0.1071-year readmission1.001.02 (0.86, 1.22)1.000.99 (0.76, 1.28)0.919Cox proportional hazards regression was used to calculate adjusted mortality and readmission. Hazard ratios were adjusted for patient demographics (age, gender, race, body mass index, marital status, employment status, living location, pet ownership, medical care payer, usual source of care, financial barriers to health care use), medical history (hypertension, depression, previous myocardial infarction, congestive heart failure), clinical presentation and treatment (left ventricular systolic function, creatinine, receipt of angiotensin-converting enzyme inhibitor and β blockers at discharge), ENRICHD Social Support Instrument score, and baseline health status scores.HR = hazard ratio. Open table in a new tab Table 5Adjusted one-year health status measurementsHealth Status MeasurementLiving Alone (n = 471)Not Living Alone (n = 1,793)Difference (live alone vs not living alone)p ValueMean (95% CI)Seattle Angina Questionnaire quality-of-life score, mean ± SE73.3 ± 4.476.2 ± 4.4−2.9 (−5.5, −0.2)0.034Short Form-12 Physical Component Scale score, mean ± SE38.6 ± 2.437.5 ± 2.41.0 (−0.6, 2.7)0.2080Short Form-12 Mental Component Scale score, mean ± SE48.0 ± 2.148.9 ± 2.1−0.9 (−2.3, 0.5)0.2175Multivariate linear regression models were used to calculate adjusted mortality and readmission. Data are reported as mean health status measurements adjusted for patient demographics (age, gender, race, body mass index, marital status, employment status, living location, pet ownership, medical care payer, usual source of care, financial barriers to health care use), medical history (hypertension, depression, previous myocardial infarction, congestive heart failure), clinical presentation and treatment (left ventricular systolic function, creatinine, receipt of angiotensin-converting enzyme inhibitor and β blockers at discharge), ENRICHD Social Support Instrument score, and baseline health status scores. Open table in a new tab Table 6Demographic and clinical predictors of mortality, rehospitalization, and health statusClinical OutcomePredictors of Increased Mortality, Rehospitalization, or Worse Health StatusPredictors of Decreased Mortality, Rehospitalization, or Improved Health Status1-year mortalitydemographic and medical history: living in nursing home or assisted-living facility, hypertension, CHFdemographic and medical history: obesityclinical presentation and treatment: moderate/severe LVSD, increased creatinine4-year mortalitydemographic and medical history: increased age, female gender, Medicaid insurance, previous AMI, CHFdemographic and medical history: full-time employment, obesityclinical presentation and treatment: moderate/severe LVSD, increased creatininebaseline health status measurements: increased ESSI score1-year rehospitalizationdemographic and medical history: female gender, living in nursing home or assisted-living facility, hypertension, CHFdemographic and medical history: increased age, full-time employmentclinical presentation and treatment: increased creatinine1-year Seattle Angina Questionnairedemographic and medical history: female gender, homeless or renting home, reported difficulty obtaining medical care, receipt of depression medication or counseling, previous AMIdemographic and medical history: increased age, commercial or Medicare insuranceclinical presentation and treatment: receipt of β blockers at dischargebaseline health status measurements: increased ESSI score1-year Short Form-12 Physical Component Scaledemographic and medical history: female gender, pet ownership, having usual source of care, reported difficulty obtaining medical care, underweight, obesity, receipt of depression medication or counseling, previous AMIdemographic and medical history: part-time employment1-year Short Form-12 Mental Component Scaledemographic and medical history: homeless, avoidance of medical care because of cost, receipt of depression medication or counselingdemographic and medical history: increased ageclinical presentation and treatment: increased creatininebaseline health status measurements: increased ESSI scoreCHF = congestive heart failure; LVSD = left ventricular systolic dysfunction. Open table in a new tab Cox proportional hazards regression was used to calculate adjusted mortality and readmission. Hazard ratios were adjusted for patient demographics (age, gender, race, body mass index, marital status, employment status, living location, pet ownership, medical care payer, usual source of care, financial barriers to health care use), medical history (hypertension, depression, previous myocardial infarction, congestive heart failure), clinical presentation and treatment (left ventricular systolic function, creatinine, receipt of angiotensin-converting enzyme inhibitor and β blockers at discharge), ENRICHD Social Support Instrument score, and baseline health status scores. HR = hazard ratio. Multivariate linear regression models were used to calculate adjusted mortality and readmission. Data are reported as mean health status measurements adjusted for patient demographics (age, gender, race, body mass index, marital status, employment status, living location, pet ownership, medical care payer, usual source of care, financial barriers to health care use), medical history (hypertension, depression, previous myocardial infarction, congestive heart failure), clinical presentation and treatment (left ventricular systolic function, creatinine, receipt of angiotensin-converting enzyme inhibitor and β blockers at discharge), ENRICHD Social Support Instrument score, and baseline health status scores. CHF = congestive heart failure; LVSD = left ventricular systolic dysfunction. Living alone appears to be associated with poorer angina-related quality of life at 1 year and a higher risk of mortality at 4 years after MI. Differences in mortality were attenuated after multivariate adjustment indicating that certain patient and clinical characteristics explain some of the relation between mortality and living alone. Nevertheless, our results suggest that patients living alone may be at greater risk of adverse outcomes. These results are consistent with a few studies that have found a positive association between living alone and worse outcomes after AMI. Data from the Multicenter Diltiazem Postinfarction Trial showed that living alone was a significant predictor of recurrent cardiac events including nonfatal infarction and cardiac death up to 4 years after AMI.2Case R.B. Moss A.J. Case N. McDermott M. Eberly S. Living alone after myocardial infarction Impact on prognosis.JAMA. 1992; 267: 515-519Crossref PubMed Scopus (404) Google Scholar Similarly, in a study of women after AMI, Norekvål et al8Norekvål T.M. Fridlund B. Rokne B. Segadal L. Wentzel-Larsen T. Nordrehaug J.E. Patient-reported outcomes as predictors of 10-year survival in women after acute myocardial infarction.Health Qual Life Outcomes. 2010; 8: 140-149Crossref PubMed Scopus (40) Google Scholar observed a higher rate of 10-year mortality in women living alone. In contrast, Schmaltz et al9Schmaltz H.N. Southern D. Ghali W.A. Jelinski S.E. Parsons G.A. King K.M. Maxwell C.J. Living alone, patient sex and mortality after acute myocardial infarction.J Gen Intern Med. 2007; 22: 572-578Crossref PubMed Scopus (74) Google Scholar found that men, but not women, who lived alone had a higher risk of 3-year mortality than those who lived with others. Although most studies examining this relation have found a positive unadjusted association between living alone and mortality, some have found no differences in mortality or reported that these differences did not persist after adjustment. For example, in a population-based study of elderly patients, Berkman et al10Berkman L.F. Leo-Summers L. Horwitz R.I. Emotional support and survival after myocardial infarctionA prospectivepopulation-based study of the elderly.Ann Intern Med. 1992; 117: 1003-1009Crossref PubMed Scopus (667) Google Scholar found no difference in survival in patients living alone versus those living with others; however, they did find that lack of emotional support was significantly associated with 6-month mortality. Similarly, in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) III trial, patients living alone had a higher crude mortality at 1 year than patients living with others, but these differences became nonsignificant after adjustment for patient age, gender, race, and region of enrollment.3O'Shea J.C. Wilcox R.G. Skene A.M. Stebbins A.L. Granger C.B. Armstrong P.W. Bode C. Ardissino D. Emanuelsson H. Aylward P.E. White H.D. Sadowski Z. Topol E.J. Califf R.M. Ohman E.M. Comparison of outcomes of patients with myocardial infarction when living alone versus those not living alone.Am J Cardiol. 2002; 90: 1374-1377Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar These observed inconsistencies in results may be explained in part by methodologic differences in patient demographics, sample size, and length of follow-up. Several mechanisms have been proposed to explain the relation between living alone and patient outcomes ranging from lack of medical supervision and poor adherence to neurohumoral responses associated with human contact and psychological distress.2Case R.B. Moss A.J. Case N. McDermott M. Eberly S. Living alone after myocardial infarction Impact on prognosis.JAMA. 1992; 267: 515-519Crossref PubMed Scopus (404) Google Scholar Because patients with AMI are at greater risk of psychological stress and depression, living alone may serve to exacerbate the link between these factors and adverse cardiovascular outcomes by limiting social support and use of mental health resources. In fact, patients in PREMIER who lived alone were more likely to be receiving medication or counseling for depression and to have lower ESSI social support scores compared to patients who lived alone. Similarly, patients who live alone may be less likely to adhere to medication regimens and follow-up recommendations without the supervision and financial support of others. However, these mechanisms likely vary by age and other patient characteristics. One such characteristic that deserves mentioning is marital status. In our sample, a larger percentage of patients living alone were divorced compared to those living with others (32.1% vs 9.1%), which may have increased patient levels of stress or further limited their access to social support. Although we controlled for marital status in our multivariable models, we may have been unable to fully adjust for the effects of marital status on patient outcomes. Several studies have found that marriage is an important predictor of survival after MI in short11Gerward S. Tydén P. Engström G. Hedblad B. Marital status and occupation in relation to short-term case fatality after a first coronary event—a population based cohort.BMC Public Health. 2010; 10: 235-242Crossref PubMed Scopus (24) Google Scholar and long12Chandra V. Szklo M. Goldberg R. Tonascia J. The impact of marital status on survival after an acute myocardial infarction: a population-based study.Am J Epidemiol. 1983; 117: 320-325PubMed Google Scholar term. However, it is unclear whether this association is independent of other psychosocial factors including social support and living alone. For example, Welin et al13Welin C. Lappas G. Wilhelmsen L. Independent importance of psychosocial factors for prognosis after myocardial infarction.J Intern Med. 2000; 247: 629-639Crossref PubMed Scopus (230) Google Scholar found that marital status, marital strain, and dissatisfaction with family life were not significantly associated with mortality after first infarction after adjustment for social support. Similarly, findings from the Multicenter Diltiazem Postinfarction Trial suggest that having a disrupted marriage is not a significant predictor of recurrent cardiac events after controlling for living alone.2Case R.B. Moss A.J. Case N. McDermott M. Eberly S. Living alone after myocardial infarction Impact on prognosis.JAMA. 1992; 267: 515-519Crossref PubMed Scopus (404) Google Scholar Limitations of this study include possible self-report bias on interview and survey questions and an inability to characterize changes in living arrangements during follow-up. In addition, excluding patients with missing data on living arrangements may have biased the results if the outcomes of these patients differed from those included in the sample. However, we believe this is unlikely because of the small number of patients with missing data (n = 53). The findings of this study may not be generalizable to other patient populations, particularly elderly or rural populations. Nevertheless, this study has several strengths including a large multicenter sample, prospective long-term follow-up, and data on numerous patient and clinical characteristics. Our data suggest that living alone is associated with poorer quality of life after MI and higher crude mortality, although differences in mortality may be attributable to differences in clinical characteristics." @default.
• W2021619703 created "2016-06-24" @default.
• W2021619703 creator A5010880605 @default.
• W2021619703 creator A5015021993 @default.
• W2021619703 creator A5036122212 @default.
• W2021619703 creator A5045353661 @default.
• W2021619703 creator A5047622393 @default.
• W2021619703 creator A5082758922 @default.
• W2021619703 creator A5088028306 @default.
• W2021619703 creator A5089219571 @default.
• W2021619703 date "2011-10-01" @default.
• W2021619703 modified "2023-10-16" @default.
• W2021619703 title "Effect of Living Alone on Patient Outcomes After Hospitalization for Acute Myocardial Infarction" @default.
• W2021619703 cites W1931914938 @default.
• W2021619703 cites W1999432427 @default.
• W2021619703 cites W2033672491 @default.
• W2021619703 cites W2054962877 @default.
• W2021619703 cites W2055647821 @default.
• W2021619703 cites W2097871157 @default.
• W2021619703 cites W2109647832 @default.
• W2021619703 cites W2116226337 @default.
• W2021619703 cites W2129948416 @default.
• W2021619703 cites W2130845577 @default.
• W2021619703 cites W2146322422 @default.
• W2021619703 cites W2172151487 @default.
• W2021619703 cites W4254100730 @default.
• W2021619703 doi "https://doi.org/10.1016/j.amjcard.2011.05.023" @default.
• W2021619703 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/3670597" @default.
• W2021619703 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/21798499" @default.
• W2021619703 hasPublicationYear "2011" @default.
• W2021619703 type Work @default.
• W2021619703 sameAs 2021619703 @default.
• W2021619703 citedByCount "50" @default.
• W2021619703 countsByYear W20216197032012 @default.
• W2021619703 countsByYear W20216197032013 @default.
• W2021619703 countsByYear W20216197032014 @default.
• W2021619703 countsByYear W20216197032015 @default.
• W2021619703 countsByYear W20216197032016 @default.
• W2021619703 countsByYear W20216197032017 @default.
• W2021619703 countsByYear W20216197032018 @default.
• W2021619703 countsByYear W20216197032019 @default.
• W2021619703 countsByYear W20216197032020 @default.
• W2021619703 countsByYear W20216197032021 @default.
• W2021619703 countsByYear W20216197032022 @default.
• W2021619703 countsByYear W20216197032023 @default.
• W2021619703 crossrefType "journal-article" @default.
• W2021619703 hasAuthorship W2021619703A5010880605 @default.
• W2021619703 hasAuthorship W2021619703A5015021993 @default.
• W2021619703 hasAuthorship W2021619703A5036122212 @default.
• W2021619703 hasAuthorship W2021619703A5045353661 @default.
• W2021619703 hasAuthorship W2021619703A5047622393 @default.
• W2021619703 hasAuthorship W2021619703A5082758922 @default.
• W2021619703 hasAuthorship W2021619703A5088028306 @default.
• W2021619703 hasAuthorship W2021619703A5089219571 @default.
• W2021619703 hasBestOaLocation W20216197031 @default.
• W2021619703 hasConcept C126322002 @default.
• W2021619703 hasConcept C164705383 @default.
• W2021619703 hasConcept C500558357 @default.
• W2021619703 hasConcept C71924100 @default.
• W2021619703 hasConceptScore W2021619703C126322002 @default.
• W2021619703 hasConceptScore W2021619703C164705383 @default.
• W2021619703 hasConceptScore W2021619703C500558357 @default.
• W2021619703 hasConceptScore W2021619703C71924100 @default.
• W2021619703 hasFunder F4320337338 @default.
• W2021619703 hasIssue "7" @default.
• W2021619703 hasLocation W20216197031 @default.
• W2021619703 hasLocation W20216197032 @default.
• W2021619703 hasLocation W20216197033 @default.
• W2021619703 hasLocation W20216197034 @default.
• W2021619703 hasOpenAccess W2021619703 @default.
• W2021619703 hasPrimaryLocation W20216197031 @default.
• W2021619703 hasRelatedWork W2049397185 @default.
• W2021619703 hasRelatedWork W2120735623 @default.
• W2021619703 hasRelatedWork W2237746437 @default.
• W2021619703 hasRelatedWork W2316107365 @default.
• W2021619703 hasRelatedWork W2367140913 @default.
• W2021619703 hasRelatedWork W2377483921 @default.
• W2021619703 hasRelatedWork W2399063111 @default.
• W2021619703 hasRelatedWork W2411183214 @default.
• W2021619703 hasRelatedWork W2437485626 @default.
• W2021619703 hasRelatedWork W4232554619 @default.
• W2021619703 hasVolume "108" @default.
• W2021619703 isParatext "false" @default.
• W2021619703 isRetracted "false" @default.
• W2021619703 magId "2021619703" @default.
• W2021619703 workType "article" @default.