Living alone after myocardial infarction. Impact on prognosis

JAMA. 1992 Jan 22-29;267(4):515-9.


Objective: To determine if the presence of a disrupted marriage or living alone would be an independent prognostic risk factor for a subsequent major cardiac event following an initial myocardial infarction.

Design: Prospective evaluation in the placebo wing of a randomized, double-blind drug trial in patients with an enzyme-documented acute myocardial infarction who were admitted to a coronary care facility. Data for living alone and/or a marital disruption were entered into a Cox proportional hazards model constructed from important physiologic and nonphysiologic factors in the same database.

Setting: Multicenter trial in a mixture of community and academic hospitals in the United States and Canada.

Patients: All consenting patients who were 25 to 75 years of age and without other serious diseases were enrolled (placebo, N = 1234) within 3 to 15 days of the index infarction and followed for a period of 1 to 4 years (mean, 2.1 years). Nine hundred sixty-seven patients were followed for 1.1 years and 530 for 2.2 years.

Primary outcome measure: Recurrent major cardiac event (either recurrent nonfatal infarction or cardiac death).

Results: Living alone was an independent risk factor, with a hazard ratio of 1.54 (95% confidence interval, 1.04 to 2.29; P less than .03). Using the Kaplan-Meier statistical method for calculation, the recurrent cardiac event rate at 6 months was 15.8% in the group living alone vs 8.8% in the group not living alone. Risk remained significant throughout the follow-up period (P = .001). A disrupted marriage was not an independent risk factor.

Conclusion: Living alone but not a disrupted marriage is an independent risk factor for prognosis after myocardial infarction when compared with all other known risk factors.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Female
  • Humans
  • Incidence
  • Interpersonal Relations*
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Myocardial Infarction / psychology*
  • Prognosis
  • Proportional Hazards Models
  • Recurrence
  • Risk Factors
  • Single Person / psychology*
  • Social Environment*
  • Social Isolation
  • Social Support