Social Isolation and Social Support Influence Health Service Utilisation and Survival after a Cardiovascular Disease Event: A Systematic Review

Abstract

Both cardiovascular disease (CVD) and social health carry high health and economic burdens. We undertook a systematic review to investigate the association between social isolation, low social support, and loneliness with health service utilisation and survival after a CVD event among people living in Australia and New Zealand. Four electronic databases were systematically searched for the period before June 2020. Two reviewers undertook the title/abstract screen. One reviewer undertook a full-text screen and data extraction. A second author checked data extraction. Of 756 records, 25 papers met our inclusion criteria. Included studies recruited 10–12,821 participants, aged 18–98 years, and the majority were males. Greater social support was consistently associated with better outcomes on four of the five themes (discharge destination, outpatient rehabilitation attendance, rehospitalisation and survival outcomes; no papers assessed the length of inpatient stay). Positive social health was consistently associated with better discharge designation to higher independent living. As partner status and living status did not align with social isolation and social support findings in this review, we recommend they not be used as social health proxies. Our systematic review demonstrates that social health is considered in cardiac care decisions and plays a role in how healthcare is being delivered (i.e., outpatient, rehabilitation, or nursing home). This likely contributes to our finding that lower social support is associated with high-intensity healthcare services, lower outpatient rehabilitation attendance, greater rehospitalisation and poorer survival. Given our evidence, the first step to improve cardiac outcomes is acknowledging that social health is part of the decision-making process. Incorporating a formal assessment of social support into healthcare management plans will likely improve cardiac outcomes and survival. Further research is required to assess if support person/s need to engage in the risk reduction behaviours themselves for outpatient rehabilitation to be effective. Further synthesis of the impact of social isolation and loneliness on health service utilisation and survival after a CVD event is required.

Efficacy and Adherence Rates of a Novel Community‐Informed Virtual World‐Based Cardiac Rehabilitation Program: Protocol for the Destination Cardiac Rehab Randomized Controlled Trial

“…The integration of a social network fosters a sense of group accountability and equitable inclusion, important elements to behavioral change that are often missing in home‐based CR, possibly accounting for its suboptimal engagement. 9 , 37 , 78 , 79 Furthermore, our study team capitalized on the unique features of VW platforms in addition to the various benefits of home‐based CR to create a patient‐centric intervention that has previously demonstrated excellent adherence, with 71% of patients attending ≥75% of sessions. 44 , 45 On the basis of our prior feasibility study, we expect at least comparable, if not superior, participation in the D estination Cardiac Rehab group compared with CBCR.…”

Psychological Risk Factors in Cardiac Rehabilitation

“…However, strong social support is consistently associated with better CR attendance, fewer hospitalizations, and longer survival. 8 Programs devoted to CR should evaluate social support aligned with Medicare guidelines. Social support may be bolstered through a supportive rehabilitation environment, community resources, and individual and/ or small group education and counseling, ideally including support person(s) of patients.…”

“…Socially isolated individuals also have a greater likelihood of mortality following myocardial infarction. However, strong social support is consistently associated with better CR attendance, fewer hospitalizations, and longer survival 8. Programs devoted to CR should evaluate social support aligned with Medicare guidelines.…”