Comparison of long-term mortality between living alone patients vs. living together patients with acute coronary syndrome treated with percutaneous coronary intervention

Abstract

Aims Living alone is reported as an independent risk factor for cardiovascular disease. However, little is known about the association between clinical outcomes and living alone in patients with acute coronary syndrome (ACS). The aim of this study was to determine whether living alone is an independent prognostic risk factor for long-term mortality stratified by age in patients with ACS who were treated with primary percutaneous coronary intervention (PCI). Methods and results We conducted an observational cohort study of ACS patients who underwent PCI between January 1999 and May 2015 at Juntendo University Shizuoka Hospital, Japan. The primary endpoint was all-cause death. Among 2547 ACS patients, 381 (15.0%) patients were living alone at the onset of ACS. The cumulative incidence of all-cause death was comparable between living alone and living together (34.8% vs. 34.4%, log-rank P = 0.63). However, among younger population (aged <65 years), the incidence of all-cause death was significantly higher in the living alone group (log-rank P = 0.01). Multivariate Cox hazard analysis revealed a significant association between living alone and all-cause death, even after adjusting for other risk factors (hazard ratio 2.30, 95% confidence interval 1.38–3.84, P = 0.001). Conclusion Although living alone was not significantly associated with long-term clinical outcomes in patients with ACS, it was a predictive risk factor among younger ACS patients. Careful attention should be paid to patients’ lifestyle, especially younger patients with ACS.

Comparisons of Patients Living Alone versus Living with Others in Acute Coronary Syndrome

“…5 8 In the current study, females were more common in ACS patients living alone than those living with others, and those living alone were older, as seen in previous studies, suggesting that ACS patients living alone is essential problems in aging society. 4 5 6 7 9 11 22 23 Similarly to previous studies, 5 6 7 8 9 10 11 23 the current study shows that living alone, compared with living with others, is a predictor of cardiac mortality in 2 years. In recent years, due to the diversification of social lifestyles, common-law partners are becoming more common.…”

“…Previous reports have compared clinical background (age, gender, preexisting coronary risk factors, and clinical severity) for each type of living arrangement. Although no definitive conclusions have been reached, there are some reports that the frequency of diabetes, 4 7 hypertension, 5 10 11 and dyslipidemia 10 is higher in the group living alone than in the group living with others, suggesting that arteriosclerosis may be more advanced in the group living alone. However, morphology of coronary artery culprit lesions evaluated by intravascular imaging has not yet been compared between ACS patients living alone and those living with others.…”

“…1 2 3 Previous reports suggested that “living arrangements,” i.e., whether people live alone or with others, could be an important factor affecting outcomes in patients with ACS. 4 5 6 7 8 9 However, the mechanism by which living alone adversely affects ACS outcomes has not been clarified. ACS patients living alone may have more advanced atherosclerosis progression at the onset of ACS.…”

Bridging Care Transition After Hospitalization for Atrial Fibrillation and Coronary Interventions

“…Living alone was found to be associated with higher mortality rates in young patients with acute coronary syndromes. 31 The cost of tablets for 1 week can create a significant burden on hospital budgets. In our HMO-based integrated hospital-community system, this also requires budgetary dialog between stakeholders, 32 namely, the hospital and the community administration of the same HMO.…”

Development and Validation of a Prediction Rule for Major Adverse Cardiac and Cerebrovascular Events in High-Risk Myocardial Infarction Patients After Primary Percutaneous Coronary Intervention

“…Early primary percutaneous coronary intervention (PPCI) has been established as the first-line treatment for patients with acute myocardial infarction (MI). 1 A randomized trial of moderate size [2][3][4][5][6][7] showed a significant increase in major adverse cardio cerebral events (MACCE) post PPCI. Indeed, residual atherothrombotic risk remains substantial in high-risk patients and lesion subsets, including those older than 65 years, with renal dysfunction, diabetes mellitus (DM), thrombotic target lesions, and multi-vessel disease.…”