Impact of Marital Status on the Outcome of Acute Coronary Syndrome: Results From the Acute Coronary Syndrome Israeli Survey

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.

Marriage and mortality after acute coronary syndrome

“…As illustrated in Supplementary Figure 1, 14 potentially eligible studies with a total of 89,176 patients were identified (Table 1) (see Supplementary References 4–7). 1–10 The risk of bias of each study is summarised in Supplementary Table 1. Extracted and calculated ORs/HRs are listed in Table 1.…”

“…Adjusted ORs for early (one-day, 4 inhospital 6,7 and 30-day (see Supplementary Reference 5)) 8 mortality were available in five studies (see Supplementary Reference 5), 4,6–8 and adjusted HRs for overall (one-year 8 to 77-month (see Supplementary Reference 6)) mortality were available in eight studies (see Supplementary References 4 and 6). 1,2,5,8–10…”

“…In the primary meta-analysis combining adjusted ORs (of early mortality) and HRs (of overall mortality) for married versus unmarried (unmarried (see Supplementary References 4 and 6), 7,8–10 never married (see Supplementary Reference 5), 2,4,5 and single) 1,6 patients demonstrated that married patients were associated with significantly lower early (OR 0.55, 95% CI 0.36–0.86; I 2 = 87%, P = 0.008; Figure 1, upper panel) and overall mortality (HR 0.75, 95% CI 0.65–0.87; I 2 = 55%, P = 0.0001; Figure 1, lower panel) compared with unmarried patients. In several studies (see Supplementary References 4 and 5), 1,2,4,5–7 multiple ORs/HRs (in addition to the OR/HR for married vs. unmarried patients) were available (e.g.…”

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

“…Marriage may affect the development and prognosis of CHD through spouses encouraging each other to adopt healthy lifestyles, seek early medical attention, or comply with treatment regimens, or providing emotional support or financial security 5–7. Previous meta-analyses and population studies reported that married people had lower CHD incidence and mortality and better prognosis after CHD compared with those who were not married 8–12. The association between marriage and the risk of out-of-hospital sudden cardiac arrest has also been reported in previous studies 13 14.…”

Health Issues of Complicacy among Relationships

“…Although marriage is associated with health benefits for both men and women, research has consistently shown that men derive more benefit than women [6]. Marital status may indicate a supportive social environment of the patient with acute coronary syndrome, with the lack of this support associated with poor outcome [7]. Partnered sexuality and satisfaction with it may reduce exposure to stress, modify response to stress and promote recovery from stress, thereby reducing the risk of cardiovascular disease [8].…”