Changes in Social Role, Loneliness Could Contribute to Worse Outcomes in Heart Failure Patients

Satoshi Katano, PhD, PT

Data from a single-center study of patients hospitalized with heart failure suggests lonely heart failure patients faced a worse prognosis than their counterparts with a greater social support system.

Results of the study, which included data from more than 300 elderly patients with heart failure, suggest those impacted by social frailty were at a more than 2-fold increase in risk of the study’s composite outcome, which included all-cause mortality and cardiovascular events.

“We are the first to show a close association between the loss of perceived social role and long-term poor clinical outcomes in older heart failure patients,” said Satoshi Katano, PhD, PT, first author of this research, based at Sapporo Medical University Hospital, in a statement. “Our study highlights the real need to develop a management program that includes a social approach to the care of these patients.”

As research focuses have shifted from solely clinical to a more holistic management approach for patients, particularly those with cardiovascular conditions, interest has grown related to impact of social domains on clinical outcomes. In the present study, Katano and a team of colleagues from institutions across Japan sought to assess prognostic ability of social frailty to predict negative clinical outcomes in elderly patients hospitalized with heart failure.

Using data from Sapporo Medical University Hospital from March 1, 2015-December 31, 2020, investigators identified 310 patients hospitalized for heart failure aged 65 years or older for inclusion in their analyses. The study cohort had a median age of 79 (IQR< 72-84) years, 46% were women, and 76% were classified as having NYHA Class III heart failure.

All these patients were given a validated questionnaire using Makizako’s 5 questions to assess social frailty. These 5 questions assessed changes in social activity, social support circle, perceived changes to their social role, living situation, and daily communication tendencies. The primary outcome of interest for the study was defined as. Composite of all-cause or hospitalization for heart failure. Patients were followed for up to 3 years after enrollment of the first patient and 1 year after enrollment of the last patient.

Upon analysis, Investigators found 24% (n=75) had composite events during the follow-up period, which lasted a mean of 1.93±0.91 years. Further analysis revealed Kaplan-Meier curves showed patient with social frailty had significantly higher event rate than those without social frailty. In multivariable Cox regression analyses, results indicated social frailty was independently associated with an increased risk of events after adjustment for prognostic markers (aHR, 2.01 [95% CI, 1.07-3.78]; P=.04).

Among the 5 questions assessing domains of social frailty, results suggested “yes” responses to the question about not feeling helpful toward friends or family was an independent predictor of composite events (aHR, 2.28 [95% CI, 1.36-3.82]; P <.01). When including this into the baseline prognostic model, accuracy improved for both the continuous net reclassification improvement (0.562 [95% CI, 0.298-0.827]; P <.01) and integrated discrimination improvement (0.031 [95% CI, 0.006-0.056]; P=.02).

“Recent research has shown that social frailty is present in two thirds of older people that suffer heart failure, and it has been linked to worse outcomes for these patients. However, it hasn’t been clear exactly why social frailty makes the prognosis worse,” explained Katano. “To examine the aspects of social frailty that may contribute to poor outcomes, we measured social frailty using the Makizako questionnaire in over 300 heart failure patients over the age of 65 that were admitted to our hospital for care.”

This study, “Loss of perceived social role, an index of social frailty, is an independent predictor of future adverse events in hospitalized patients with heart failure,” was published in Frontiers in Cardiovascular Medicine.