Perceived social isolation and outcomes in patients with heart failure

Sheila M. Manemann, Alanna M. Chamberlain, Véronique L. Roger, Joan M. Griffin, Cynthia Boyd, Thomas Cudjoe, Daniel Jensen, Susan A. Weston, Matteo Fabbri, Ruoxiang Jiang, Lila J.Finney Rutten

Research output: Contribution to journalArticle

Abstract

Background--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. Methods and Results--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). Conclusions--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.

Original languageEnglish (US)
Article numbere008069
JournalJournal of the American Heart Association
Volume7
Issue number11
DOIs
StatePublished - Jun 1 2018

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Social Isolation
Heart Failure
Confidence Intervals
International Classification of Diseases
Hospital Emergency Service
Hospitalization
Social Adjustment
Outpatients

Keywords

  • Epidemiology
  • Heart failure
  • Outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Manemann, S. M., Chamberlain, A. M., Roger, V. L., Griffin, J. M., Boyd, C., Cudjoe, T., ... Rutten, L. J. F. (2018). Perceived social isolation and outcomes in patients with heart failure. Journal of the American Heart Association, 7(11), [e008069]. https://doi.org/10.1161/JAHA.117.008069

Perceived social isolation and outcomes in patients with heart failure. / Manemann, Sheila M.; Chamberlain, Alanna M.; Roger, Véronique L.; Griffin, Joan M.; Boyd, Cynthia; Cudjoe, Thomas; Jensen, Daniel; Weston, Susan A.; Fabbri, Matteo; Jiang, Ruoxiang; Rutten, Lila J.Finney.

In: Journal of the American Heart Association, Vol. 7, No. 11, e008069, 01.06.2018.

Research output: Contribution to journalArticle

Manemann, SM, Chamberlain, AM, Roger, VL, Griffin, JM, Boyd, C, Cudjoe, T, Jensen, D, Weston, SA, Fabbri, M, Jiang, R & Rutten, LJF 2018, 'Perceived social isolation and outcomes in patients with heart failure', Journal of the American Heart Association, vol. 7, no. 11, e008069. https://doi.org/10.1161/JAHA.117.008069
Manemann, Sheila M. ; Chamberlain, Alanna M. ; Roger, Véronique L. ; Griffin, Joan M. ; Boyd, Cynthia ; Cudjoe, Thomas ; Jensen, Daniel ; Weston, Susan A. ; Fabbri, Matteo ; Jiang, Ruoxiang ; Rutten, Lila J.Finney. / Perceived social isolation and outcomes in patients with heart failure. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 11.
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abstract = "Background--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. Methods and Results--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). Conclusions--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.",
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AU - Manemann, Sheila M.

AU - Chamberlain, Alanna M.

AU - Roger, Véronique L.

AU - Griffin, Joan M.

AU - Boyd, Cynthia

AU - Cudjoe, Thomas

AU - Jensen, Daniel

AU - Weston, Susan A.

AU - Fabbri, Matteo

AU - Jiang, Ruoxiang

AU - Rutten, Lila J.Finney

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N2 - Background--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. Methods and Results--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). Conclusions--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.

AB - Background--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. Methods and Results--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). Conclusions--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.

KW - Epidemiology

KW - Heart failure

KW - Outcome

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