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J Am Heart Assoc. 2018 May 23;7(11). pii: e008069. doi: 10.1161/JAHA.117.008069.

Perceived Social Isolation and Outcomes in Patients With Heart Failure.

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Department of Health Sciences Research, Mayo Clinic, Rochester, MN
Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD.
Olmsted County Public Health Services, Rochester, MN.



Perceived social isolation has been shown to have a negative impact on health outcomes, particularly among older adults. However, these relationships have not been fully examined among patients with heart failure.


Residents from 11 southeast Minnesota counties with a first-ever International Classification of Diseases, Ninth Revision (ICD-9) code 428 for heart failure between January 1, 2013, and March 31, 2015 (N=3867), were prospectively surveyed to measure perceived social isolation. A total of 2003 patients returned the survey (response rate, 52%); 1681 patients completed all questions and were retained for analysis. Among these patients (53% men; mean age, 73 years), ≈19% (n=312) had moderate perceived social isolation and 6% (n=108) had high perceived social isolation. After adjustment, patients reporting moderate perceived social isolation did not have an increased risk of death, hospitalizations, or emergency department visits compared with patients reporting low perceived social isolation; however, patients reporting high perceived social isolation had >3.5 times increased risk of death (hazard ratio, 3.74; 95% confidence interval [CI], 1.82-7.70), 68% increased risk of hospitalization (hazard ratio, 1.68; 95% CI, 1.18-2.39), and 57% increased risk of emergency department visits (hazard ratio, 1.57; 95% CI, 1.09-2.27). Compared with patients who self-reported low perceived social isolation, patients reporting moderate perceived social isolation had a 16% increased risk of outpatient visits (rate ratio, 1.16; 95% CI, 1.03-1.31), whereas those reporting high perceived social isolation had a 26% increased risk (rate ratio, 1.26; 95% CI, 1.04-1.53).


In patients with heart failure, greater perceived social isolation is associated with an increased risk of death and healthcare use. Assessing perceived social isolation during the clinical encounter with a brief screening tool may help identify patients with heart failure at greater risk of poor outcomes.


epidemiology; heart failure; outcome

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