Strengthening social ties could improve recovery rates

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A recent study found that older adults with heart failure who maintain social connection experience better outcomes. Half Point Images / Getty Images
  • In a recent study, researchers evaluated the effect of social disengagement on the prognosis of heart failure.
  • They found that socially disconnected people are more likely to experience a cardiovascular event or die within 2 years of heart failure.
  • The researchers say their findings emphasize the importance of social connection in the management of heart failure among older adults with the condition.

Around 26 million people around the world are affected by heart failure (HF), and more 80% of patients with HF are over 65 years of age. Despite advances in medicine and prevention strategies, readmission rates remain high.

Physical frailty (physical weakness, slowness, and little activity) is often bound the worse prognosis of HF, increased rehospitalization rates and poor response to cardiac rehabilitation.

Few studies have investigated how social frailty (feeling disconnected from family, friends, and other people) affects older HF patients. Understanding how social frailty affects HF prognosis could inform post-HF care policies.

Investigators recently investigated the effects of social frailty on clinical outcomes in older adults who have been hospitalized with HF.

They found that loss of perceived social role was linked to increased risk of adverse events, including cardiovascular events or death.

The study was recently published in Frontlevels in cardiovascular medicine.

For the study, the researchers recruited 310 hospitalized HF patients with an average age of 78 years. About half of those subjects were women.

Each subject answered a self-reported questionnaire asking about their social engagement, such as whether they live alone, how useful they feel to their friends and family, and whether they talk to someone every day.

The subjects were then followed for an average of about 2 years. Of the 310 patients, 61%, or 188, had social frailty. Within 2 years, 75 patients, or 24%, died or suffered another cardiovascular event.

From statistical analyses, the researchers found that patients with social frailty were about twice as likely as those without to have experienced a cardiovascular event or to die within two years of their heart failure.

The findings also show that people who felt they were not helping their friends or family were especially likely to experience a cardiovascular event or death.

When asked why social frailty may worsen the prognosis of heart failure, Angelina R. NamePh.D., a professor in the Department of Behavioral Sciences and Social Medicine at Florida State University College of Medicine, who was not involved in the study, said today’s medical news:

“Humans need social interaction and support, and there is a large body of literature showing what happens when these needs are not met.”

“People who report loneliness, for example, tend to engage in behaviors related to poor health, such as a sedentary lifestyle and substance use. [They also] they have more disease burden, poorer cognitive health, and more rapid disease progression. These factors put people at even greater risk when developing heart disease, since social disconnection has already taken a toll on the body.”

– Dr. Angelina Sutin, professor of behavioral sciences

Dr. Sutin cited related research, in particular a review and meta-analysis led, showing that several aspects of social health (loneliness, living alone, and social isolation) were associated with increased risk of mortality among people with cardiovascular disease.

Dr Johanna Contrerasan advanced heart failure and transplant cardiologist at Mount Sinai Hospital in New York, who was not involved in the study, said MNT:

“As heart failure patients age, they have a decline not only [in] physical functions, but also cognitive functions, such as remembering to take medications, managing your medications, your diet, and your oral intake.”

Dr. Contreras added that social and community support that helps patients feel motivated to get better and stay on top of medications, doctor appointments, diet and exercise can give them a better outlook.

MNT asked the study author satoshi katanoPh.D., from the Division of Rehabilitation, Sapporo Medical University Hospital, how the feeling of not being useful can affect the prognosis of HF.

“Those who believe they are not helpful have fewer social connections, worse self-efficacy and control, less social support, and lower resilience than those who believe they are helpful,” Dr. Katano explained.

“Furthermore, a poor sense of usefulness has been shown to lead to less optimal health care-seeking behaviors and reduced engagement in preventive and health-promoting activities, which subsequently influence one’s health or lead to a faster decline in health.

Research shows that the rate of heart attacks tends to increase during holidays and other notable social events.

MNT order daniel fulfordPh.D., an associate professor in Boston University’s Department of Occupational Therapy, who was not involved in the study, whether there was any association between the recent study findings and increases in heart attacks during vacations.

He noted that this is unlikely since the health effects of social fragility emerge after a long period of time.

“I would not attribute a major medical event, such as heart failure, to an acute change in social connection,” Dr. Fulford said. “Most likely, abrupt changes in diet and routine will 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 experience sharp chest pain and shortness of breath associated with extreme distress,” explained Dr. Fulford.

“While the mechanisms explaining this phenomenon are unknown, I would imagine that the acute distress of an interpersonal loss could trigger such an experience. But again, research on the impact of social disconnection and physical health outcomes suggests that these processes play out over longer periods of time,” he added.

doctor richard wrighta cardiologist at Providence Saint John’s Health Center in Santa Monica, CA, who was not involved in the study, noted that MNT:

“This study was conducted only in elderly Japanese, and the questionnaire used in the trial might not be applicable to younger people or people outside of Japan. However, the findings are likely to be universal despite these limitations.”

brad schmidtPh.D., Distinguished Research Professor and Chair of the Department of Psychology at Florida State University, noted the limitations of the study, saying that while the findings are interesting, the study has some analytical flaws.

“The measure of social fragility is confused with physical health. If you go out or socialize less, this may be due to the onset of an exacerbation of a medical condition. To deal with this, the authors need to control for medical comorbidity to isolate the effects of their SF. [social frailty] variable, and I don’t think they’ve done this.”

– Brad Schmidt, Ph.D., psychologist

Dr. Schmidt added that there is still “good data from many other studies to suggest that perceived social isolation contributes to adverse mental and physical health outcomes. As a result, facilitating social interaction is particularly important for older adults when they are most medically vulnerable.”

MNT asked Dr. Wright how people with CI could improve and strengthen their social connections.

He said simple steps can be taken to strengthen social ties and reduce the threat of social fragility. These may include:

  • maintain connections with friends and family
  • being married to or in union with a ‘significant other’
  • continue working
  • participate in volunteer positions to maintain self-esteem
  • have a pet

“Such maneuvers amplify the proven benefits of appropriate medical therapy in patients with heart failure and should ideally be incorporated into all comprehensive management programs for people with chronic medical conditions,” Dr. Wright said.

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