Social Isolation May Be Associated with Worse Outcomes in Heart Failure Patients

Among heart failure patients, those who were at risk of social isolation had a worse attitude about advance care planning.

Heart failure (HF) patients may have an increased risk of social isolation (SI), which was found to increase the risk of all-cause death in as little as 5 months, according to a study published in the Journal of the American Heart Association. During the 180-day follow-up, 14.7% of patients classified with SI died, compared to 2.3% of patients who did not experience SI.

SI may be a barrier to advanced care planning (ACP), which, “enables individuals to define and discuss goals and preferences for future medical treatment, particularly end‐of‐life (EOL) care,” the study authors wrote. “Functional aspects of social networks were associated with negative attitudes toward ACP discussions.

International HF clinical practice recommend having ACP discussions earlier in a patient’s disease state. Not having ACP and surrogate decision makers can complicate treatment and ultimately impact care goals.

The current study aimed to explain the impact of SI as a risk for patient decision-making, looking further at how this risk could impact patient preferences regarding ACP and EOL care. They used the Lubben Social Network Scale to measure the extent of SI and the results were based on patient structure, tangible aid, and emotional support. Researchers defined SI as the number of contacts with relatives/friends in the past month.

Researchers observed 120 HF patients with a high risk for SI. In the retrospective, longitudinal, and observational study, patients answered a questionnaire survey and completed an SI assessment using the Lubben Social Network Scale and offered their perspectives on ACP and EOL care.

The data show that respondents classified as at-risk for SI (SI-group) believed that “saying what one wants to tell loved ones ”and “spending enough time with family” were less important, compared to the non‐SI group. Generally, the risk for SI was also associated with a more negative attitude towards ACP conversations.

The data also show that SI was associated with a lower chance of survival after heart transplantation. In a separate meta-analysis, SI was found to affect 37% of HF patients. In a separate study, 28% of patients diagnosed with cardiac disease and subsequent HF diagnosed themselves as lonely and socially isolated in some fashion.

But a patient’s perception of SI may be unique to the individual, their environment, or their therapeutical targets.

Study limitations include its small size, single center format, and short-term follow-up. The observational study also cannot determine causation between SI and poor prognosis, nor is it free of individual bias. Finally, the study, which was conducted in Japan, might not be generalizable to other cultures, social structures, and ethnic groups, according to the authors.

It is recommended that cardiologists increase routine SI evaluation and consider solutions that lower SI, such as social prescribing, to “provide an appropriate advance care planning approach to align with patients' care goals.”

Reference

Kitakata, Hiroki, Kohno, Takashi, Kohsaka, Shun, et al. Social Isolation and Implementation of Advanced Care Planning Among Hospitalized Patients With Heart Failure. JAHA. 2022. https://doi.org/10.1161/JAHA.122.026645