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Mortality rates higher in unmarried patients with CAD
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Patients who underwent cardiac catheterization for CAD and were unmarried had an increased risk for mortality compared with those who were married, according to a study published in the Journal of the American Heart Association.
“I was somewhat surprised by the magnitude of the influence of being married has (on heart patients),” Arshed A. Quyyumi, MD, professor of medicine in the division of cardiology and co-director of Emory Clinical Cardiovascular Research Institute, said in a press release. “Social support provided by marriage and perhaps many other benefits of companionship are important for people with heart disease.”
William M. Schultz, MD, a resident in the division of cardiology at Emory Clinical Cardiovascular Research Institute at the time of the study and now a fellow in the department of medicine at Northwestern University Feinberg School of Medicine, and colleagues reviewed data from 6,051 patients (mean age, 63 years; 64% men) who underwent cardiac catheterization for known or suspected CAD between 2003 and 2015.
Interviews were conducted to collect information on medical history, demographics, socioeconomic factors, medication use and behavioral habits. Self-administered questionnaires on marital status were completed at enrollment. Patients were categorized by marital status: married (n = 4,088), divorced/separated (n = 842), widowed (n = 670) or never married (n = 451).
Follow-up was conducted by medical chart abstraction and telephone for a median of 3.7 years.
The primary outcome of interest was the combined incidence of MI and CV death. Secondary outcomes of interest included CV death and all-cause death.
All-cause death occurred in 18% of patients, 11% of patients died from CV-related causes and 4.5% had incident MI during the study period.
Patients who were unmarried had an increased risk for CV death (HR = 1.45, 95% CI, 1.18-1.78), all-cause mortality (HR = 1.24; 95% CI, 1.06-1.47) and CV death or MI (HR = 1.52; 95% CI, 1.27-1.83) compared with those who were married. The link between marital status and adverse outcomes was significant after adjusting for medications, employment and education.
The increased risk for CV death and MI was similar in patients who were never married (HR = 1.4; 95% CI, 0.97-2.03), divorced or separated (HR = 1.41; 95% CI, 1.1-1.81) or widowed (HR = 1.71; 95% CI, 1.32-2.2) vs. those who were married.
“Accounting for unmarried status in the management of patients with CAD, consideration of associated psychological conditions and potentially more aggressive follow-up and therapy need to be considered in future studies,” Schultz and colleagues wrote. – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.
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