May 23, 2018
2 min read

Social isolation increases risk for death in HF

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Patients with HF who said they felt socially isolated had increased use of health care services and an increased risk for death compared with those who did not feel isolated, according to a study published in the Journal of the American Heart Association.

“Our study expands upon previous research by reporting on the association of perceived social isolation and outcomes in a large, community-based cohort of patients with heart failure and utilizing the PROMIS Social Isolation Short Form which could be readily adopted into clinical practice,” Sheila M. Manemann, MPH, senior health services analyst and assistant professor of epidemiology in the department of health sciences research at Mayo Clinic, told Cardiology Today. “Furthermore, along with studying hospitalization and ED visits, we also reported on outpatient visits to get a more complete picture of the association between perceived social isolation and health care utilization.”

Social isolation and HF

Researchers analyzed data from 1,681 participants (mean age, 73 years; 53% men) with HF between January 2013 and March 2015.

Participants completed a survey on their perceived social isolation and other sociobehavioral measures. Four items regarding isolation were scored on a 5-point scale and ranged from 4 to 20. Based on these scores, participants were categorized by perceived social isolation: low (4-8), moderate (9-12) and high (13-20).

The researchers also calculated Charlson Comorbidity Index scores for each participant. Depression status was attained from ICD-9 codes.

Follow-up was conducted from survey completion to Dec. 31, 2015, for a mean of 8 months. Outcomes of interest included ED visits, hospitalizations, death and outpatient visits.

Based on the surveys, 19% of participants reported moderate perceived social isolation and 6% reported high levels of isolation.

Compared with participants who reported low perceived social isolation, those with moderate social isolation did not have a statistically significant increase in the risk for death (HR = 1.4; 95% CI, 0.74-2.65), hospitalization (HR = 1.02; 95% CI, 0.74-1.4) or ED visits (HR = 1.13; 95% CI, 0.85-1.5).

Increased risk

After adjusting for sex, age, marital status, education and Charlson Comorbidity Index, participants with high perceived social isolation had an increased risk for death (HR = 3.74; 95% CI, 1.82-7.7), hospitalizations (HR = 1.68; 95% CI, 1.18-2.39) and ED visits (HR = 1.57; 95% CI, 1.09-2.27) vs. those with low perceived social isolation. Results were similar when adjusting for depression.

Participants with moderate perceived social isolation had increased risk for outpatient visits compared with those with low perceived social isolation (RR = 1.16; 95% CI, 1.03-1.31). This increased risk was also seen in participants with high perceived social isolation (RR = 1.26; 95% CI, 1.04-1.53).

“Our findings suggest that measuring perceived social isolation in clinical practice through the use of a brief screening tool may help identify patients with heart failure who are at a greater risk for death and hospitalization and thus may benefit from targeted interventions,” Manemann said in an interview. “Future research is needed to understand the mechanism by which perceived social isolation leads to poor outcomes in patients with heart failure.” – by Darlene Dobkowski

For more information:

Sheila M. Manemann, MPH, can be reached at

Disclosures: Manemann reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.