- In a recent study, researchers examined the impact of social disconnectivity on the prognosis of heart failure.
- They found that people who are socially disconnected are more likely to have a cardiovascular event or die of heart failure within 2 years.
- The researchers stress that their findings underscore the importance of social connectedness in treating heart failure in older adults with this condition.
Heart failure (HF) affects around 26 million people worldwide, and over 80% of HF patients are over 65 years of age. Despite advances in medicine and prevention strategies, readmission rates remain high.
Physical frailty — physical weakness, slowness, and low activity — is often associated with poorer HF prognosis, increased rehospitalization rates, and a poor response to cardiac rehabilitation.
Only a few studies have examined how social frailty — the feeling of being separated from family, friends, and others — affects older HF patients. Understanding how social frailty affects HF prognosis could influence RF aftercare guidelines.
Recently, researchers investigated the impact of social frailty on clinical outcomes in older adults hospitalized with HF.
They found that loss of perceived social role was associated with an increased risk of side effects, including cardiovascular events or death.
The study was recently published in Frontiers in Cardiovascular Medicine.
How “social frailty” affects heart failure
For the study, the researchers recruited 310 HF patients in hospital with an average age of 78 years. Around half of these test subjects were female.
Each subject answered a questionnaire asking about their social commitment, such as whether they live alone, how useful they feel for friends and family, and whether they talk to anyone every day.
The test subjects were then observed for an average of around 2 years. Of the 310 patients, 61% — or 188 — were socially frail. Within 2 years, 75 patients — or 24% — either died or there was another cardiovascular event.
Statistical analyses showed that patients with social frailty were approximately twice as likely to develop heart failure within two years as those who did not have a cardiovascular event or died of heart failure within two years.
The results also show that people who felt they were unhelpful to friends or family were particularly likely to experience a cardiovascular event or death.
The importance of social connectedness
Asked why social frailty can worsen the prognosis of heart failure, Angelina R. Sutin, Ph.D., a professor in the Department of Behavioral Sciences and Social Medicine at Florida State University College of Medicine, not involved in the study, told Medical News Today:
“People need social interaction and support, and there is extensive literature showing what happens when these needs aren’t met.”
“People who report loneliness, for example, tend to display health-damaging behaviors such as lack of exercise and drug use. [They] also have a higher disease burden, poor cognitive health, and faster disease progression. These factors increase the risk of developing heart disease even more, as social separation has already taken a heavy toll on the body.”
— Dr. Angelina Sutin, Professor of Behavioral Sciences Dr. Sutin, cited related research findings, in particular one from
her review and meta-analysis, which showed that various aspects of social health — loneliness, living alone and social isolation — were associated with an increased risk of mortality among people with cardiovascular diseases.
Dr. Johanna Contreras, an advanced heart failure and transplant cardiologist at Mount Sinai Hospital in New York, who was not involved in the study, told MNT:
“As patients with heart failure get older, not only physical but also cognitive functions decline, such as remembering to take medications, their diet, and taking them orally.”
Dr. Contreras added that social support and community that help patients motivate themselves to perform better and keep up with medications, doctor appointments, and diet and exercise can give patients a better prognosis.
Feeling useful can lead to better results
MNT asked study author Satoshi Katano, Ph.D., from the Department of Rehabilitation at Sapporo Medical University Hospital how feeling of not being useful may affect the HF prognosis.
“Those who believe they are not helpful have fewer social connections, poorer self-efficacy and control, less social support, and lower resilience than those who consider themselves useful,” explained Dr. Katano.
“In addition, it has been shown that a poor sense of use leads to less optimal behavior when seeking health services and to lower participation in preventive and health-promoting activities, which subsequently affects one’s own health or leads to a faster decline in health.”
Heart attacks on public holidays
Research shows that the incidence of heart attacks tends to increase during holidays and other important social events.
MNT asked Daniel Fulford, Ph.D., psychologist and associate professor at Boston University, who wasn’t involved in the study, whether there was a link between the latest study findings and the increase in heart attacks over the holidays.
He found that this is unlikely, as the health effects of social frailty only occur after a long period of time.
“I wouldn’t attribute a serious medical event such as heart failure to an acute change in social connection,” Dr. Fulford said. “It is most likely abrupt dietary and routine changes that increase the risk of such events during the holidays.”
MNT asked Dr. Fulford how these findings might be related to broken heart syndrome.
“In broken heart syndrome or takotsubo cardiomyopathy, people suffer from acute chest pain and shortness of breath associated with extreme stress,” explained Dr. Fulford.
“The mechanisms that explain this phenomenon are unknown, but I could imagine that the acute burden of an interpersonal loss could trigger such an experience. But here too, research on the effects of social separation and physical health outcomes suggests that these processes unfold over longer periods of time,” he added.
Limitations of research on “social frailty”
Dr. Richard Wright, a cardiologist at Providence Saint John’s Health Center in Santa Monica, California, not involved in the study, told MNT:
“This study was only conducted on older Japanese people, and the questionnaire used in the study may not be appropriate for younger people or people outside Japan. However, despite these limitations, the results are likely to be universal.”
Brad Schmidt, Ph.D., distinguished research professor and chair at Florida State University’s Department of Psychology, pointed out the limitations of the study and said that while the results are interesting, the study has some analytical flaws.
“The level of social fragility is mistaken for physical health. If you go out less or socialize less, this may be due to the onset of an illness getting worse. To counter this, the authors must control medical comorbidity to isolate the effects of their SF variables [social frailty], and I don’t think they did that.”
— Brad Schmidt, Ph.D., the psychologist
Dr. Schmidt added that there is still “good data from many other studies that suggest that perceived social isolation contributes to negative mental and physical health outcomes. Therefore, promoting social interaction is particularly important for older adults when they are more medically vulnerable.”
Strengthening social connections
MNT asked Dr. Wright how people with HF could improve and strengthen their social connections.
He said simple measures can be taken to strengthen social ties and reduce the risk of social weakness. This may include:
- Maintaining relationships with friends and family, married or with
- connected to a “partner”, others
- Participating in volunteer positions to maintain self-esteem
- Owning a pet
. “Such maneuvers reinforce the proven benefits of appropriate medical therapy for patients with heart failure and should ideally be included in all comprehensive treatment programs for people with chronic conditions,” said Dr. Wright.