Background: Social isolation has been shown to have a negative impact on psychosocial and physical health, particularly among older adults. However, these relationships have not been fully examined among patients with heart failure (HF).
Methods: Residents from 11 southeast MN counties with a first-ever ICD-9 code 428 for HF between 1/1/2013 and 3/31/2014 (N=1649) were mailed a survey to measure social isolation (PROMIS Social Isolation Short Form) and functional status and mental health (PROMIS 29 Health Profile). A total of 778 patients returned the survey (response rate 47%), and among these, 645 completed all questions and were retained for analysis. Patients who returned a completed survey were similar on age (p=0.15), sex (p=0.80), and Charlson comorbidity index (p=0.28) to those who did not return or returned an incomplete survey. The relationship between social isolation and functional status and mental health was analyzed using linear regression, adjusted for age, sex, and Charlson comorbidity index.
Results: Among 645 patients with HF, 53% were men, the mean age was 73 years, and the mean Charlson index was 2.2. The mean scores for each functional and mental health subscale and the total score increased with increasing severity of social isolation (Table). For example, the mean physical function scores were 8.6, 11.3, and 12.8 and the mean depression scores were 5.0, 7.3, and 9.8 for those with low, moderate, and high social isolation, respectively. In addition, the total score increased from 51.1 among those with low social isolation to 80.2 for those with high social isolation. Observed differences persisted after adjustment for age, sex, and comorbidity.
Conclusion: In patients with HF, greater social isolation is associated with worse functional and mental health, independent of comorbidity. As functional status and mental health impact disease management, addressing social isolation may help with managing HF.