The impact of perceived and objective social isolation on hospital readmission in patients with heart failure: A systematic review and meta-analysis of observational studies

Gorji, M A Heidari; Fatahian, Alireza; Farsavian, Ali Asghar

doi:10.1016/j.genhosppsych.2019.07.002

Cited by 55 publications

(49 citation statements)

References 47 publications

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“…[139][140][141] In the context of CVDs, the absence of positive relationships and the reduced chance of interaction with other people (social distancing) have been identified as major risk factors for CV mortality. [142][143][144][145][146][147][148][149][150][151] A recent meta-analysis including a total of 181 006 participants 152 demonstrated that the risk for ischaemic heart disease and stroke increased by 29% and 32%, respectively, in lonely and socially isolated people. Similar results were reported from a UK Biobank analysis.…”

Section: Cardiovascular Implications Of Social Distancingmentioning

confidence: 99%

COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options

Guzik

Mohiddin

Dimarco³

et al. 2020

Cardiovascular Research

1,267

1,347

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The novel coronavirus disease (COVID-19) outbreak, caused by SARS-CoV-2, represents the greatest medical challenge in decades. We provide a comprehensive review of the clinical course of COVID-19, its comorbidities, and mechanistic considerations for future therapies. While COVID-19 primarily affects the lungs, causing interstitial pneumonitis and severe acute respiratory distress syndrome (ARDS), it also affects multiple organs, particularly the cardiovascular system. Risk of severe infection and mortality increase with advancing age and male sex. Mortality is increased by comorbidities: cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer. The most common complications include arrhythmia (atrial fibrillation, ventricular tachyarrhythmia, and ventricular fibrillation), cardiac injury [elevated highly sensitive troponin I (hs-cTnI) and creatine kinase (CK) levels], fulminant myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation (DIC). Mechanistically, SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane angiotensin-converting enzyme 2 (ACE2) —a homologue of ACE—to enter type 2 pneumocytes, macrophages, perivascular pericytes, and cardiomyocytes. This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction (MI). While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis. Hence, patients should not discontinue their use. Moreover, renin–angiotensin–aldosterone system (RAAS) inhibitors might be beneficial in COVID-19. Initial immune and inflammatory responses induce a severe cytokine storm [interleukin (IL)-6, IL-7, IL-22, IL-17, etc.] during the rapid progression phase of COVID-19. Early evaluation and continued monitoring of cardiac damage (cTnI and NT-proBNP) and coagulation (D-dimer) after hospitalization may identify patients with cardiac injury and predict COVID-19 complications. Preventive measures (social distancing and social isolation) also increase cardiovascular risk. Cardiovascular considerations of therapies currently used, including remdesivir, chloroquine, hydroxychloroquine, tocilizumab, ribavirin, interferons, and lopinavir/ritonavir, as well as experimental therapies, such as human recombinant ACE2 (rhACE2), are discussed.

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Section: Cardiovascular Implications Of Social Distancingmentioning

confidence: 99%

COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options

Guzik

Mohiddin

Dimarco³

et al. 2020

Cardiovascular Research

1,267

1,347

View full text Add to dashboard Cite

show abstract

“…In particular, longitudinal data indicate that social isolation is associated with increased risk of several physical and mental health outcomes, cardiovascular disease, hospital readmission in heart failure patients, early mortality, cognitive impairment, and depression. 3,[23][24][25]27,[36][37][38][39][40] However, the findings are all based on observational studies and do not provide evidence on the causal direction of the association. Poor physical and mental health can lead to social isolation, and social isolation can lead to poorer health.…”

Section: Discussionmentioning

confidence: 98%

“…The meta-analyses conducted with longitudinal studies indicate that social isolation is associated with increased risk of cardiovascular disease, 23 early mortality, 3,24 and hospital readmission in heart failure patients. 25 The 15 meta-analyses on mental health were based on a total of 416 primary studies. The reported results are based on sample sizes ranging from 1,345 26 to 2,330,163 27 participants, with one meta-analysis failing to report on the sample size.…”

Section: Quality Assessmentmentioning

confidence: 99%

A potential impact of physical distancing on physical and mental health. A rapid narrative umbrella review of meta-analyses on the link between social isolation and health

Morina

Kip

Hoppen

et al. 2020

Preprint

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Background: The imperative for physical distancing during the coronavirus disease 2019 (COVID-19) pandemic may deteriorate physical and mental health. We aimed at summarizing the strength of evidence in the published literature on the association of social isolation and loneliness with physical and mental health. Methods: We conducted a systematic search in April 2020 to identify meta-analyses using the Medline, PsycINFO, and Web of Science databases. The search strategy included terms of social isolation, loneliness, living alone, and meta-analysis. Eligible meta-analyses needed to report any sort of association between an indicator of social isolation and any physical or mental health outcome. The findings were summarized in a narrative synthesis. Results: Twenty-five meta-analyses met our criteria, of which 10 focused on physical health and 15 on mental health outcomes. A total of more than 3 million individuals had participated in the 692 primary studies. The results suggest that social isolation is associated with chronic physical symptoms, frailty, coronary heart disease, malnutrition, hospital readmission, reduced vaccine uptake, early mortality, depression, social anxiety, psychosis, cognitive impairment in later life, and suicidal ideation. Conclusions: The existing evidence clearly indicates that social isolation is associated with a range of poor physical and mental health outcomes. A potential negative impact on these outcomes needs to be considered in future decisions on physical distancing measures.

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“…This measure of social isolation reflects social connectedness; whether a person has friends or family members to talk to about important issues or to call when they need help. Social isolation is linked to higher rates of disability, poorer recovery from illness and death (26–28). The 9-item Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms with a score of five used as a cut-point for depressive symptoms (29).…”

Section: Methodsmentioning

confidence: 99%

Geriatric Conditions and Prescription of Vitamin K Antagonists vs. Direct Oral Anticoagulants Among Older Patients With Atrial Fibrillation: SAGE-AF

McManus

Kiefe

Lessard

et al. 2019

Front. Cardiovasc. Med.

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Background: Geriatric conditions are common among patients with atrial fibrillation (AF) and relate to complications of oral anticoagulation (OAC).Objective: To examine the prevalence of geriatric conditions among older patients with AF on OAC and relate type of OAC to geriatric conditions.Methods: Participants had a diagnosis of AF, were aged ≥65 years, CHA2DS2VASC ≥ 2, and had no OAC contraindications. Participants completed a 6-component geriatric assessment that included validated measures of frailty (CHS Frailty Scale), cognitive function (MoCA), social support (MOS), depressive symptoms (PHQ9), vision, and hearing. Type of OAC prescribed was documented in medical records.Results: 86% of participants were prescribed an OAC. These participants were on average aged 75.7 (SD: 7.1) years, 49% were women, two thirds were frail or pre-frail, and 44% received a DOAC. DOAC users were younger, had lower CHA2DS2VASC and HAS-BLED scores, and were less likely to be frail. In Massachusetts, pre-frailty was associated with a significantly lower odds of DOAC vs. VKA use (OR = 0.64, 95%CI 0.45, 0.91). Pre-frailty (OR = 0.33, 95%CI 0.18–0.59) and social isolation (OR = 0.38, 95%CI 0.14–0.99) were associated with lower odds of DOAC receipt in patients aged 75 years or older. Social isolation was associated with higher odds of DOAC use (OR = 2.13, 95%CI 1.05–4.29) in patients aged 65–74 years.Conclusions: Geriatric conditions were common and related to type of OAC prescribed, differentially by age group. Research is needed to evaluate whether a geriatric examination can be used clinically to better inform OAC decision-making in older patients with AF.

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The impact of perceived and objective social isolation on hospital readmission in patients with heart failure: A systematic review and meta-analysis of observational studies

Cited by 55 publications

References 47 publications

COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options

COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options

A potential impact of physical distancing on physical and mental health. A rapid narrative umbrella review of meta-analyses on the link between social isolation and health

Geriatric Conditions and Prescription of Vitamin K Antagonists vs. Direct Oral Anticoagulants Among Older Patients With Atrial Fibrillation: SAGE-AF

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