Social isolation may increase HF risk; association modified by feelings of loneliness
Self-reported social isolation and loneliness could indicate increased risk for incident HF, according to research published in JACC: Heart Failure.
Yannis Yan Liang, MD, PhD, of the Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital and Guangdong Academy of Medical Sciences in Guangdong, China, and colleagues observed that the association between social isolation and incident HF risk may be modified by feelings of loneliness.
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“‘Social isolation’ refers to being objectively alone or having infrequent social connections, whereas ‘loneliness’ is defined as a painful feeling caused by a discrepancy between one’s desire for connections and the actual degree of connections,” the researchers wrote. “Despite compelling evidence linking social isolation and loneliness to multiple cardiovascular outcomes and premature mortality, less is known about their association with HF.”
Liang and colleagues evaluate social isolation and loneliness among 464,773 UK Biobank study participants who completed self-reported questionnaires (mean age, 57 years; 45% men). Participants with HF were identified using linked hospital record data and death registries.
Overall, 40.4% reported being moderately isolated, 14.3% reported being mostly isolated and 4.8% had feelings of loneliness.
During a median follow-up of 12.3 years, 13% of the cohort developed HF.
Compared with participants reporting less isolation or loneliness, participants with more isolation or loneliness were more likely to be men with unhealthy lifestyle factors and obesity and a history of chronic diseases including ischemic heart disease and diabetes.
Similarly, participants with incident HF had more unhealthy factors, obesity and a history of chronic diseases compared with those without incident HF, according to the study.
Isolation, loneliness and incident HF
Researchers observed that participants reporting the most social isolation (adjusted HR = 1.17; 95% CI, 1.11-1.23) and loneliness (aHR = 1.19; 95% CI, 1.11-1.27) experienced greater risk for incident HF compared with those reporting the least amount of isolation and those reporting no loneliness; however, the interaction between isolation and incident HF was modified by loneliness (P for interaction = .034).
Moreover, researchers also found that social isolation was only a risk factor for incident HF when loneliness was not present (P for trend < .001).
“These findings indicate that the impact of subjective loneliness was more important than that of objective social isolation,” Jihui Zhang, MD, PhD, a researcher at Guangzhou Medical University, said in a press release “These results suggest that when loneliness is present, social isolation is no more important in linking with heart failure. Loneliness is likely a stronger psychological stressor than social isolation because loneliness is common in individuals who are hostile or have stressful social relationships and bridges the link between social isolation and depression.”
‘Social care’ in clinical practice
In a related editorial, Sarah J. Goodlin, MD, geriatrician, palliative care physician and president of Patient-Centered Education and Research in Portland, Oregon, and Sheldon H. Gottlieb, MD, cardiologist at Johns Hopkins University School of Medicine, discussed the potential of integrating “social care” into clinical practice.
“Social isolation and loneliness should probably be included in the intake assessment of all patients, but especially those with cardiometabolic disease who are at great risk of incident HF,” they wrote. “Addressing loneliness, social isolation and other social determinants of health will require transformation of health care delivery to integrate social care. We suggest that the current focus on loneliness and social isolation is a ‘call to action’ for health care delivery systems, insurers and others involved in population health.”
References:
- Goodlin SJ, et al. JACC Heart Fail. 2023;doi:10.1016/j.jchf.2023.01.002.
- Social isolation, loneliness increase risk for heart failure. https://www.eurekalert.org/news-releases/977950. Published Feb. 1, 2023. Accessed Feb. 1, 2023.
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