The Impacts of Living Alone in in-Hospital and One-Year Clinical Outcomes after Acute Myocardial Infarction in Korean Patients

Joon Ho Ahn; Hyun Kuk Kim; Jong Yoon Kim; Jumin Won; Hyeong Won Seo; Young Joon Hong; Ju Han Kim; Myung Ho Jeong; Jeong Gwan Cho; Jong Chun Park; Sook Hee Cho; Youngkeun Ahn

doi:10.12997/jla.2015.4.2.115

Journal List > J Lipid Atheroscler > v.4(2) > 1059552

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Ahn, Kim, Kim, Won, Seo, Hong, Kim, Jeong, Cho, Park, Cho, and Ahn: The Impacts of Living Alone in in-Hospital and One-Year Clinical Outcomes after Acute Myocardial Infarction in Korean Patients

Original Article

Journal of Lipid and Atherosclerosis 2015; 4(2): 115-121.

Published online: 31 December 2015

DOI: https://doi.org/10.12997/jla.2015.4.2.115

The Impacts of Living Alone in in-Hospital and One-Year Clinical Outcomes after Acute Myocardial Infarction in Korean Patients

Joon Ho Ahn¹, Hyun Kuk Kim¹, Jong Yoon Kim¹, Jumin Won¹, Hyeong Won Seo¹, Young Joon Hong¹, Ju Han Kim¹, Myung Ho Jeong¹, Jeong Gwan Cho¹, Jong Chun Park¹, Sook Hee Cho², Youngkeun Ahn¹

¹Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.

²Department of Nursing, Mokpo National University, Mokpo, Korea.

Corresponding Author: Youngkeun Ahn, Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, 671 Jebong-ro, Dong-gu, Gwangju 501-757, Korea. Tel: +82-62-220-4764, Fax: +82-62-224-4764, cecilyk@hanmail.net

Received 20 May 2015 Revised 2 August 2015 Accepted 10 September 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The aim of this study is to evaluate the impact of living alone for in-hospital and one-year clinical outcome after acute myocardial infarction (AMI) in Korean patients.

Methods

A total of 1,700 patients who admitted at the Chonnam National University Hospital were analyzed. We divided the patients into two groups by the existence of a spouse or family member that lived together with the patient at the first time of hospital visit due to AMI. The primary endpoint was composed of in-hospital death and cardiac death during one-year clinical follow-up. Secondary end point was other major adverse cardio-cerebral events (MACCE) including non-fatal MI, repeat revascularization, ischemic or hemorrhagic stroke during one-year clinical follow-up.

Results

Living alone patient group had higher proportion of Killip class II-IV (34.3% vs. 26.6%, p=0.006) and higher value of high sensitivity C-reactive protein (2.2±4.0 vs. 1.5±3.4 ng/mL, p=0.019) than not living alone group. In-hospital death (8.9 % vs. 5.1%, p=0.010) and one-year cardiac death (7.7% vs. 4.6%, p=0.031) developed more in living alone groups. However, living alone was not an independent prognostic factor for in-hospital death (HR 1.51, 95% CI 0.91-2.52, p=0.113) and one-year cardiac death (HR 1.18, 95% CI 0.59-2.34, p=0.64) after multivariate analysis.

Conclusion

Living alone was not an independent prognostic factor for in-hospital and one-year clinical outcome after AMI.

Keywords: Living alone, Myocardial infarction, Prognosis

Figures and Tables

Fig. 1

Study flow chart

Fig. 2

Kaplan Meier curve of cardiac death free survival

Table 1

Baseline clinical characteristics

Values are presented as the n (%) of patients or mean±SD or median (25-75 percentiles)

CAD; Coronary artery disease, STEMI; ST segment elevation myocardial infarction, LDL; Low Density Lipoprotein, HDL; High density Lipoprotein, hs-CRP; High sensitivity C-reactive protein, NT-pro-BNP; N-terminal pro-B-type natriuretic peptide

Table 2

Baseline coronary angiographic and procedural characteristics

Values are presented as the n (%) of patients or mean±SD.

TIMI; thrombolysis in myocardial infarction

Table 3

Medications at discharge

Values are presented as the n (%) of patients.

Table 4

Incidence of one-year MACCE

Values are presented as the n (%) of patients or mean±SD.

MACCE; major adverse cardio-cerebral events, MI; Myocardial infarction, HF; Heart failure

Table 5

Risks for in-hospital death

^*Adjusted HR was calculated by Cox regression analysis

HR; hazard ratio, CI; confidence interval, TIMI; thrombolysis in myocardial infarction, eGFR; estimated glomerular filtration rate

Table 6

Risks for one-year cardiac death

^*Adjusted HR was calculated by Cox regression analysis

HR; hazard ratio, CI; confidence interval, hs-CRP; high sensitivity C reactive protein, eGFR; estimated glomerular filtration rate

References

1. Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. World Heart Federation and the Preventive Cardiovascular Nurses Association. AHA/ ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011; 124:2458–2473.

2. Welin C, Lappas G, Wilhelmsen L. Independent importance of psychosocial factors for prognosis after myocardial infarction. J Intern Med. 2000; 247:629–639.

3. Nakatani D, Sakata Y, Suna S, Usami M, Matsumoto S, Shimizu M, Osaka Acute Coronary Insufficiency Study (OACIS) Investigators, et al. Incidence, predictors, and subsequent mortality risk of recurrent myocardial infarction in patients following discharge for acute myocardial infarction. Circ J. 2013; 77:439–446.

4. Lee SS. Population policy and its challenges. Health Welf Policy Forum. 2014; 207:41–52.

5. Lee MJ, Choi YJ, Lee SS. An exploratory study of the characteristics of one-person household and its social implication. Kookmin Soc Sci Rev. 2014; 27:229–253.

6. Vujcic I, Vlajinac H, Dubljanin E, Vasiljevic Z, Matanovic D, Maksimovic J, et al. Long-term prognostic significance of living alone and other risk factors in patients with acute myocardial infarction. Ir J Med Sci. 2015; 184:153–158.

7. Bucholz EM, Rathore SS, Gosch K, Schoenfeld A, Jones PG, Buchanan DM, et al. Effect of living alone on patient outcomes after hospitalization for acute myocardial infarction. Am J Cardiol. 2011; 108:943–948.

8. Schmaltz HN, Southern D, Ghali WA, Jelinski SE, Parsons GA, King KM, et al. Living alone, patient sex and mortality after acute myocardial infarction. J Gen Intern Med. 2007; 22:572–578.

9. Case RB, Moss AJ, Case N, McDermott M, Eberly S. Living alone after myocardial infarction. Impact on prognosis. JAMA. 1992; 267:515–519.

10. O'Shea JC, Wilcox RG, Skene AM, Stebbins AL, Granger CB, Armstrong PW, et al. Comparison of outcomes of patients with myocardial infarction when living alone versus those not living alone. Am J Cardiol. 2002; 90:1374–1377.

11. Kitamura T, Sakata Y, Nakatani D, Suna S, Usami M, Matsumoto S, et al. Living alone and risk of cardiovascular events following discharge after acute myocardial infarction in Japan. J Cardiol. 2013; 62:257–262.

12. Neubeck L, Freedman SB, Clark AM, Briffa T, Bauman A, Redfern J. Participating in cardiac rehabilitation: a systematic review and meta-synthesis of qualitative data. Eur J Prev Cardiol. 2012; 19:494–503.

13. Astin F, Atkin K, Darr A. Family support and cardiac rehabilitation: A comparative study of the experiences of South Asian and White-European patients and their carer's living in the United Kingdom. Eur J Cardiovasc Nurs. 2008; 7:43–51.

14. Pedersen SS, van Domburg RT, Larsen ML. The effect of low social support on short-term prognosis in patients following a first myocardial infarction. Scand J Psychol. 2004; 45:313–318.

15. Gopinath B, Rochtchina E, Anstey KJ, Mitchell P. Living alone and risk of mortality in older, community-dwelling adults. JAMA Intern Med. 2013; 173:320–321.

16. Frasure-Smith N, Lespérance F, Gravel G, Masson A, Juneau M, Talajic M, et al. Social support, depression, and mortality during the first year after myocardial infarction. Circulation. 2000; 101:1919–1924.

17. O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 127:e362–e425.

18. Goldberg RJ, Spencer FA, Fox KA, Brieger D, Steg PG, Gurfinkel E, et al. Prehospital Delay in Patients With Acute Coronary Syndromes (from the Global Registry of Acute Coronary Events [GRACE]). Am J Cardiol. 2009; 103:598–603.

19. Nakatsuma K, Shiomi H, Watanabe H, Morimoto T, Taniguchi T, Toyota T, et al. CREDO-Kyoto AMI Investigators. 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; 114:522–527.

20. Atzema CL, Austin PC, Huynh T, Hassan A, Chiu M, Wang JT, et al. Effect of marriage on duration of chest pain associated with acute myocardial infarction before seeking care. CMAJ. 2011; 183:1482–1491.

21. Park YH, Kang GH, Song BG, Chun WJ, Lee JH, Hwang SY, et al. Factors related to prehospital time delay in acute ST-segment elevation myocardial infarction. J Korean Med Sci. 2012; 27:864–869.

22. Kirchberger I, Heier M, Kuch B, von Scheidt W, Meisinger C. Presenting symptoms of myocardial infarction predict short- and long-term mortality: the MONICA/KORA Myocardial Infarction Registry. Am Heart J. 2012; 164:856–861.

23. Brković E, Novak K, Puljak L. Pain-to-hospital times, cardiovascular risk factors, and early intrahospital mortality in patients with acute myocardial infarction. Ther Clin Risk Manag. 2015; 11:209–216.

24. Wilkinson J, Foo K, Sekhri N, Cooper J, Suliman A, Ranjadayalan K, et al. Interaction between arrival time and thrombolytic treatment in determining early outcome of acute myocardial infarction. Heart. 2002; 88:583–586.

25. Green P, Newman JD, Shaffer JA, Davidson KW, Maurer MS, Schwartz JE. Relation of patients living without a partner or spouse to being physically active after acute coronary syndromes (from the PULSE accelerometry substudy). Am J Cardiol. 2013; 111:1264–1269.

TOOLS

Similar articles