In the Journals

Loneliness elevates mortality, cardiac events within 1 year of discharge

Anne Vinggaard Christensen

Self-reported loneliness or living alone at the time of hospital discharge was found to be a predictor of cardiac events in men and all-cause mortality in both men and women, according to findings published in BMJ Heart.

Researchers observed that loneliness was a statistically significant predictor of all-cause mortality among both men (HR = 2.14; 95% CI, 1.43-3.22) and women (HR = 2.92; 95% CI, 1.55-5.49). Living alone was also predictive of cardiac events in men only (HR = 1.39; 95% CI, 1.05-1.85).

“This study confirms what has also been indicated in previous research regarding the serious health consequences of loneliness,” Anne Vinggaard Christensen, PhD student at the Heart Centre at Copenhagen University Hospital, Denmark, told Healio. “We knew that there was a connection between loneliness and poor health outcomes, but we were surprised by the strength of the association. Loneliness should be considered a serious risk factor in patients with cardiac disease and should be included in risk evaluation of patients. Furthermore, public health initiatives should aim at reducing loneliness.”

Impact on mental health

Moreover, women who reported loneliness had an approximately 2.7 times higher odds of reporting symptoms of anxiety and depression and a significantly lower quality of life score compared with women not feeling lonely, according to the study.

Similarly, men who reported loneliness also reported significantly worse mental and physical component scores, quality of life scores and had approximately three times higher odds of reporting symptoms of anxiety and depression compared with men who did not report loneliness.

“The results of this study show that women and men who feel lonely report significantly poorer mental and physical health, quality of life and are more likely to report anxiety and depression symptoms,” the researchers wrote. “In both women and men, living alone was associated with reduced risk of anxiety symptoms. After adjustment for potential confounders, loneliness was associated with a significantly increased risk of all-cause mortality among women and men. Among men only, living alone predicted increased risk of cardiac events.”

In other findings, researchers found no statistically significant interaction between patients who live alone and self-reported loneliness.

“Loneliness is very complex and can have many causes and it can occur even if you have people around you,” Christensen said in an interview. “For some it would be a help if they had a close family member who always remembers to ask how they are doing and is ready to listen. For others, help with practical things might be what they need, and for some, the opportunity to talk to other patients who have gone through the same thing is helpful. So, the answer is probably that it depends very much on the individual. And for clinicians the most important step is to recognize it as a risk factor and include it in risk assessment of cardiac patients.”

Design and limitations

“Because of the design of this study, it is not possible to make conclusions about causal mechanisms,” the researchers wrote. “There is a possibility of reverse causality, as it is unknown whether loneliness or disease came first. Furthermore, the feeling of loneliness can change within the first year after hospital discharge.”

Using Danish national registers, researchers analyzed 13,443 patients with ischemic heart disease (53%), arrhythmia (32%), HF (7%) and heart valve disease (7%). Patients completed a single question survey of loneliness, and cohabitation was determined using national registers. According to the study, patient-reported outcomes at hospital discharge were SF-12, Hospital Anxiety and Depression Scale (HADS) and HeartQoL. Clinical outcomes were all-cause mortality as well as 1-year cardiac events that included MI, stroke, cardiac arrest and ventricular tachycardia/fibrillation.

“Self-reported outcomes are by nature subjective, and therefore, sources of bias may exist,” the researchers wrote. “Recall bias is the most serious problem in epidemiological surveys. Social desirability bias can be an issue in self-reporting of lifestyle factors or a sensitive subject such as loneliness. However, there is little reason to suspect that such possible bias should differ systematically according to, for example, loneliness.” – by Scott Buzby

For more information:

Anne Vinggaard Christensen can be reached at anne.vinggaard.christensen@regionh.dk.

Disclosures: Christensen and the other authors report no relevant financial disclosures.

Anne Vinggaard Christensen

Self-reported loneliness or living alone at the time of hospital discharge was found to be a predictor of cardiac events in men and all-cause mortality in both men and women, according to findings published in BMJ Heart.

Researchers observed that loneliness was a statistically significant predictor of all-cause mortality among both men (HR = 2.14; 95% CI, 1.43-3.22) and women (HR = 2.92; 95% CI, 1.55-5.49). Living alone was also predictive of cardiac events in men only (HR = 1.39; 95% CI, 1.05-1.85).

“This study confirms what has also been indicated in previous research regarding the serious health consequences of loneliness,” Anne Vinggaard Christensen, PhD student at the Heart Centre at Copenhagen University Hospital, Denmark, told Healio. “We knew that there was a connection between loneliness and poor health outcomes, but we were surprised by the strength of the association. Loneliness should be considered a serious risk factor in patients with cardiac disease and should be included in risk evaluation of patients. Furthermore, public health initiatives should aim at reducing loneliness.”

Impact on mental health

Moreover, women who reported loneliness had an approximately 2.7 times higher odds of reporting symptoms of anxiety and depression and a significantly lower quality of life score compared with women not feeling lonely, according to the study.

Similarly, men who reported loneliness also reported significantly worse mental and physical component scores, quality of life scores and had approximately three times higher odds of reporting symptoms of anxiety and depression compared with men who did not report loneliness.

“The results of this study show that women and men who feel lonely report significantly poorer mental and physical health, quality of life and are more likely to report anxiety and depression symptoms,” the researchers wrote. “In both women and men, living alone was associated with reduced risk of anxiety symptoms. After adjustment for potential confounders, loneliness was associated with a significantly increased risk of all-cause mortality among women and men. Among men only, living alone predicted increased risk of cardiac events.”

In other findings, researchers found no statistically significant interaction between patients who live alone and self-reported loneliness.

“Loneliness is very complex and can have many causes and it can occur even if you have people around you,” Christensen said in an interview. “For some it would be a help if they had a close family member who always remembers to ask how they are doing and is ready to listen. For others, help with practical things might be what they need, and for some, the opportunity to talk to other patients who have gone through the same thing is helpful. So, the answer is probably that it depends very much on the individual. And for clinicians the most important step is to recognize it as a risk factor and include it in risk assessment of cardiac patients.”

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Design and limitations

“Because of the design of this study, it is not possible to make conclusions about causal mechanisms,” the researchers wrote. “There is a possibility of reverse causality, as it is unknown whether loneliness or disease came first. Furthermore, the feeling of loneliness can change within the first year after hospital discharge.”

Using Danish national registers, researchers analyzed 13,443 patients with ischemic heart disease (53%), arrhythmia (32%), HF (7%) and heart valve disease (7%). Patients completed a single question survey of loneliness, and cohabitation was determined using national registers. According to the study, patient-reported outcomes at hospital discharge were SF-12, Hospital Anxiety and Depression Scale (HADS) and HeartQoL. Clinical outcomes were all-cause mortality as well as 1-year cardiac events that included MI, stroke, cardiac arrest and ventricular tachycardia/fibrillation.

“Self-reported outcomes are by nature subjective, and therefore, sources of bias may exist,” the researchers wrote. “Recall bias is the most serious problem in epidemiological surveys. Social desirability bias can be an issue in self-reporting of lifestyle factors or a sensitive subject such as loneliness. However, there is little reason to suspect that such possible bias should differ systematically according to, for example, loneliness.” – by Scott Buzby

For more information:

Anne Vinggaard Christensen can be reached at anne.vinggaard.christensen@regionh.dk.

Disclosures: Christensen and the other authors report no relevant financial disclosures.