Lonely heart patients at greater risk of death after hospital discharge finds study

By Dr. Ananya Mandal, MDNov 5 2019

A new study has found that cardiac patients who are lonely are at a greater risk of death within a year of their discharge from the hospital. The study results were published in the latest online issue of the journal Heart.

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Researchers from Copenhagen have explained that persons with heart disease who are lonely are at a greater risk of dying and loneliness should be considered among other public health initiatives among persons who are seriously ill. They call it a “legitimate health risk”. They add that there is evidence that persons who suffer from loneliness are at a greater risk of coronary heart disease and death. To explore the relationship between loneliness and heart disease they undertook this study and looked at the health outcomes of patients who were admitted to a specialist heart care centre for heart conditions such as ischemic heart disease, heart failure, valve disease or abnormal heart rhythm etc.

For this study the team included patients from Denmark who completed the questionnaire at discharge. Their health outcomes were recorded at the end of one year between 2013 and 2014. The completed questionnaires could be obtained from 53 percent of the initial population, or a total of 13,443 patients only.

The average age of the patients was 66 years and most of the individuals were men (70 percent). The questionnaire asked the individuals about their physical health, quality of life based on the Short Form 12; HeartQoL, levels of their depression and anxiety based on the HADS scale and the general psychological wellbeing. They were also asked about other factors such as compliance to the medications they were prescribed, smoking and drinking etc. The status of their homes and family was also found out from the national databases.

Not surprisingly, those that said that they were lonely were three times more likely to be depressed or anxious and had a significantly low quality of life. Those that reported loneliness were also the ones that were more likely to have died at the end of the one year irrespective of the diagnosis of their heart disease for which they had been admitted. Loneliness also meant that their health was poorer after one year, the team found. As part of their study results the team also noted that women who were lonely were three times more likely to die compared to women who were not lonely. To come to this conclusion the team took into consideration other factors including lifestyle choices and health related behaviours.

According to researchers loneliness could now be considered as one of the important determinant factors of poor health. They also noted that living alone was not associated with feeling lonely in many individuals. However, living alone was found to be associated with a reduced risk of anxiety and depression compared to persons who lived with others. Living alone was associated with a 39 percent greater risk of heart health among men they noted. The researchers explain that women tend to have a wider network of family and friends and thus being separated, divorces or widowed did not put them at a disadvantage of being as lonely as men in the same situations.

Researchers warn however that this was only an observational study and being lonely did not always mean early death. They wrote, “However, the findings are in line with previous research, suggesting that loneliness is associated with changes in cardiovascular, neuroendocrine and immune function as well as unhealthy lifestyle choices which impact negative health outcomes... There are indications that the burden of loneliness and social isolation is growing.” In conclusion they wrote, “Furthermore, increasing evidence points to their influence on poor health outcomes being equivalent to the risk associated with severe obesity. Public health initiatives should therefore aim at reducing loneliness.”

Related study

A 2016 study from the University of York looked at scientific evidence that reveals that risk of heart attacks and strokes rose with loneliness. The study was a meta-analysis looking at around 181,000 people.

The team of researchers found that loneliness as well as social isolation could raise the risk of heart attacks and angina by 29 percent and raise the risk of a stroke by 32 percent. For this study they looked at 23 different studies that followed participants between three and 21 years.

In their study the team defined loneliness as, “a subjective negative feeling associated with someone’s perception that their relationships with others are deficient”. Three of the studies looked at loneliness, 18 studies looked at social isolation and two studies looked at a mix of both situations. The researchers explained the loneliness and social isolation are not the same condition bout both can lead to unhealthy lifestyle choices such as smoking, being physically inactive etc.

Christopher Allen, Senior Cardiac Nurse from the BHF said, “Social isolation is a serious issue that affects many thousands of people across the UK. We know that loneliness, and having few social contacts, can lead to poor lifestyle habits such as smoking, which can increase your risk of heart disease and stroke.” The team of researchers suggest that persons affected by loneliness need to seek help and also should take steps to improve their quality of life and well being such as volunteering or joining community groups etc.