Living alone and clinical outcomes in patients with heart failure with preserved ejection fraction.

OBJECTIVE In patients with heart failure with preserved ejection fraction (HFpEF), whether living alone could contribute to a poor prognosis remains unknown. We sought to investigate the association of living alone with clinical outcomes in patients with HFpEF. METHODS Symptomatic patients with HFpEF with a follow-up of 3.3 years (data collected from August 2006 to June 2013) in the TOPCAT trial were classified as patients living alone and those living with others. The primary outcome was defined as a composite of cardiovascular death, aborted cardiac arrest, or HF hospitalization. RESULTS A total of 3,103 patients with HFpEF were included; 25.2% of them were living alone and were older, predominantly female, and less likely to be white and have more comorbidities than the other patients. After multivariate adjustment for confounders, living alone was associated with increased risks of HF hospitalization (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.03-1.61) and any hospitalization (HR 1.26, 95% CI 1.12-1.42). A significantly increased risk of any hospitalization (HR 1.16, 95% CI 1.01-1.34) was also observed in the Americas-based sample. In addition, each year increase in age, female sex, non-white race, New York Heart Association functional classes III and IV, dyslipidemia, and chronic obstructive pulmonary disease were independently associated with living alone. CONCLUSIONS We assessed the effect of living arrangement status on clinical outcomes in patients with HFpEF and suggested that living alone was associated with an independent increase in any hospitalization.