Table 3 Summary table of outcomes of included studies

(Riegel and Carlson⁵⁶)

Mean age:

Usual care: 73.28 years (SD 13.09)

Intervention: 72.64 (SD 13.0)

Total: 72.95 (SD 12.97)

Number of participants:

Usual care: 43

Intervention group: 45

Total: 88

Females: 51 (58%)

NYHA classification:

I—4.5%

II—31.8%

III—44.4%

IV—19.3%

Comorbidity Scores: Low 42% Med 36.4% High 21.6%

“Minor difference reported in the intervention group (F = 5.94, P = 0.004). No significant group differences in heart failure readmissions, length of stay, or cost were evident at 90-days were reported.”

SI: Seventeen items from the UCLA social Support Inventory

Yes

SI: Which support is sought and received and satisfaction with the support: Information or advice, tangible assistance or aid, and emotional support (Dunkel-Schetter et al.⁹⁵).

(Deka et al.⁵³)

Mean age:

Experimental: 61.7 (SD 11.3) Comparison: 67.7 (SD 11.4)

Total: 64.7 (SD 11.5)

Number of participants:

Experimental: 15

Comparison: 15

Total: 30

Females: 11

NYHA classification proportions: I—3, II—17, III—10

“Overall Video session attendance was 68%, with 73% of participants attending five or more sessions. Adherence to exercise was 58.8% in the experimental group and 57.3% in the comparison group. The experimental group perceived receiving social support through the internet-based synchronized face-to-face video meetings but due to a small sample size and lack of adequate power, no significant impact on exercise adherence was observed. Participants commented that feedback regarding physical activity from the Fitbit Charge HR was helpful and motivational.”

SI: Friendship scale for perceived social isolation.

Yes

SI: Social connection, relatability, loneliness and contact with others for emotional support. (Hawthorne⁹⁶)

(Nichols et al.⁵⁴)

Mean age:

74.8 (SD 10.3)

N = 468

Females: 243 (52%)

LVEF < 40% = 3.7%

41–49% = 2.3%

>50% = 50.7%

“After two mailings, we received 468 completed questionnaires for response rate of 23.4%. Patients with a recent HF hospitalization had significantly lower scores on the KCCQ-12 Quality of Life (52.6 vs. 59.6, p = 0.016) and Social Limitations (48.4 vs. 55.5, p = 0.009) scales as well as the Clinical Summary Scale (50.8 vs. 55.3, p = 0.048) and Total KCCQ-12 score (49.6 vs. 56.8, p = 0.003). In sequential logistic regression models designed to achieve parsimony, Total KCCQ was a strong predictor of being in the recent hospitalization group. When using the KCCQ-12 sub-scales, the Social Limitations scale was a strong predictor of being in the recent hospitalization group.”

SI: Kansas City Cardiomyopathy Questionnaire Social Limitations Domain

Yes

This instrument is used for heart failure patients exclusively and measures the impairment heart failure causes the patient to partake in several social activities (Green et al. ⁵⁵).

(Liang et al.¹⁸)

Mean age: 56.5 (SD 8.1)

Females: 254230 (54.7%)

N = 464,773

Lived alone: 85,991

“Among the 464,773 participants (mean age: 56.5SD 8.1 years, 45.3% male), 12,898 incident HF cases were documented during a median follow-up of 12.3 years. Social isolation (most vs least: adjusted HR: 1.17; 95% CI:1.11–1.23) and loneliness (yes vs no: adjusted HR: 1.19; 95% CI: 1.11–1.27) were significantly associated with an increased risk of incident HF. The association between an elevated risk of HF and social isolation was modified by loneliness (P-interaction ¼ 0.034). A gradient of association between social isolation and the risk of incident HF was found only among individuals without loneliness (P-trend < 0.001), but not among those with loneliness (P-trend ¼ 0.829). These associations were independent of the genetic risk of HF.”

SI: Modified version of the Berkman-Syme Social Network Index.

LO: Loneliness was assessed with 2 questions that were derived from the UCLA-LS

No

SI: Social network and contact’s index (Berkman and Syme⁷⁵).

LO: Loneliness (Russell⁶⁹).

(Savitz et al.⁴⁸)

Mean age:

73.4 (SD 12.0)

Females: 1419 (45.2%)

“Latent class analysis was used to identify subgroups of SRFs; associations with outcomes were examined. A total of 3142 patients with HF (mean age, 73.4 years; 45% women) had SRF data available. The SRFs with the strongest association with hospitalizations were education, social isolation, and area‐deprivation index. We identified 4 groups using latent class analysis, with group 3, characterized by more SRFs, at increased risk of emergency department visits (hazard ratio [HR], 1.33 [95% CI, 1.23–1.45]) and hospitalizations (HR, 1.42 [95% CI, 1.28–1.58])”

LO: PRO-MIS Social Isolation Short Form 4a v2.0

Yes

LO: Loneliness (Cella et al.,⁷²; Organization⁷³; PROMIS Health Organization,⁷⁴.

(Yildirim et al.⁶⁰)

Mean age: 63.56 (SD 12.74)

N = 150

Females: 59 (39.3%)

“The patients had a mean age of 63.56 ± 12.74 years. Most of the patients (82%) were treated in the ICU for heart failure. There was a statistically significant. positive correlation between total scores of TDAS and UCLA-LS (r = 0.337; p < 0.001) and a statistically significant negative correlation between total scores of UCLA-LS and HHI (r = 0.292; p < 0.001). Also, there was a statistically significant negative correlation between the scores of UCLA-LS and Positive Readiness and Expectancy Subscale (r = 0.164; p = 0.044). The multiple linear regression indicated that the model was statistically significant (F = 7.177, p < 0.001). The variables of age and UCLA-LS among those included in the model were statistically significant predictors of the death anxiety scores of the patients (23.1%) (p < 0.05).”

LO: UCLA-LS adapted into Turkish language

Yes

LO: Emotional loneliness, social loneliness, and existential loneliness (Russell⁶⁹).

(Brouwers et al.⁶¹)

Mean age: 66.7 (SD 8.7)

N = 268

Females: 66 (24%)

NYHA Classification: I/II—237 (90.5%) III—31 (10%)

“At baseline, NYHA class, body mass index, educational level, Type D personality and loneliness were significantly associated with depression.

Higher NYHA class (B = 2.25; SE = 0.83), higher educational level (B = 1.41;

SE = 0.48), Type D personality (B = 2.56; SE = 0.60) and loneliness (B = .19; SE = .05) were also independently associated with higher depression levels at one-year follow-up (all p < .005). Inflammation, brain natriuretic peptide and left ventricular ejection fraction were not related to depression over time.”

LO: UCLA-LS

Yes

LO: emotional loneliness, social loneliness, and existential loneliness (Russell⁶⁹).

(Obiegło et al.⁵²)

Mean age: 62.3 (SD 12.2)

N = 100

Females: 32 (32%)

NYHA Classification: II—10, III—54, IV—36

“The patients presenting with low levels of acceptance of illness (8–18 points) scored significantly higher on the energy, pain, emotional reaction, sleep, social isolation and mobility domains of the NHP. Multivariate analysis showed that acceptance of illness was the only independent predictor of quality of life in all the NHP domains: energy (β = −0.653, p < 0.001), pain (β = −1.464, p < 0.001), emotional reactions (β –1.738, p < 0.001), sleep (β = −0.820, p < 0.001), social isolation (β = −0.638, p < 0.001) and mobility (β = −1.739, p < 0.001). Male gender proved to be an independent predictor of lower pain scores (β = −1.320, p = 0.001) and divorce was associated with higher social isolation scores (β = 1.948, p < 0.001).”

SI: Nottingham Health Profile (NHP) questionnaire sub-scale for social isolation

Yes

SI: Social isolation (Wiklund⁹⁷).

(Athilingam et al.⁶²)

Mean age: 61.7 (SD 8.8)

N = 38

Females: 12 (31.6%)

LVEF Mean 27.7%

NYHA Classification: I—4 (10.5%), II—20 (52.6%), III—14 (36.7%)

Lived alone: 6 (15.8%)

“In the multiple linear regressions, the covariate set consisting of education, living arrangements, and UCLA loneliness score explained 46% of the total variation in MoCA scores (Table IV). When IL-6 was added to the model, an additional 11% of the variation in MoCA score was explained and IL-6 was independently associated with MoCA score (P < 0.001).

Parameter estimates of the covariates and IL-6 (log-transformed) are provided (Table V). IL-6 was strongly but inversely associated with MoCA score after controlling for covariates education, living arrangements, and UCLA loneliness score. When IL-6, TNF-a, and CRP were entered stepwise, the model was significant”

LO: UCLA-LS

Yes

LO: Emotional loneliness, social loneliness, and existential loneliness (Russell⁶⁹).

(Longman et al.⁵⁰)

Mean age: 77.1 (range 66–95)

N = 102

Females: 39 (16%)

Comorbidity scores: 0–28 (27.5%) 1-2–55 (53.9%) >3–19 (18.6%)

Lived alone: 36 (35%)

“Survey respondents (n = 102) had a mean age of 77.1 years (range 66–95 years), and a mean of 4.1 admissions within 12 months; 49% had at least three chronic conditions; the majority had low socioeconomic status; one in five (22%) reported some difficulty affording their medication; and 35% lived alone. The majority reported psychological distress with 31% having moderate or severe psychological distress. While all had a GP, only 38% reported having a written GP care plan. 22% of those who needed regular help with daily tasks did not have a close friend or relative who regularly cared for them. Factors independently associated with more frequent (n = 4+) relative to less frequent (n = 3) admissions included having congestive heart failure (p = 0.003), higher social isolation scores (p = 0.040) and higher Charlson Comorbidity Index scores (p = 0.049). Most respondents (61%) felt there was nothing that could have avoided their most recent admission, although some potential avoidability of admission was described around medication and health behaviors. Respondents were younger and less sick than non-respondents.”

The Duke Social Support Index using four items on the size of respondent’s social networks and amount of social con-tact.

Yes

Social networks and loneliness index (Koenig et al.,⁸⁰; Landerman et al.⁷⁹).

(Keyes et al.⁴⁹)

Mean age: Early Readmissions: 83.3

Late and Non-Readmissions: 82.4

N = 286.

Females

Early Readmissions: 52 (55.3%)

Late and Non-Readmissions: 121 (63.0%)

Total sample: 173 (60.45%)

Lived alone: 53

“There were no statistically significant differences between earlier hospital readmissions versus later/non-readmitted sample patients when grouped by age, race, gender, or level of measured social isolation. However, composite comorbidity scores were significantly lower for patients in the >30-day/non-readmitted subgroup compared to earlier readmission patients.”

SI: Self-reported status of: Currently unmarried,2. Lives alone, and 3. Lacks caregiver.

LO: Measured as a “Yes” or “No” responses

No

SI: Perceived support network.

LO: Loneliness.

(Murberg³⁴)

Mean age: 66 (SD 9.1)

N = 119

Females: 34 (28.6%)

NYHA Classification: I—2 (1.7%), II—71 (59.7%), III—43 (36.1%), IV—3 (2.5%)

“Fifty-one deaths were registered during the six-year follow-up period, all from cardiac causes. Analysis using proportional hazard models indicated that social isolation was a significant predictor of mortality (relative risk, 1.36; confidence interval, 1.04–1.78; p < 0.03), controlling for neuroticism, heart failure severity, functional status, gender, and age. The small sample size was a limitation of the study; therefore, further research is required in order to confirm these findings and to illuminate the mechanisms behind the relationships between social isolation and mortality.”

SI: Social isolation was assessed on the basis of four items.Perceived social support was assessed by a 15-item scale.

No

Perceived social support, and Social Isolation with contact with family, other relatives, and friends.

(Griffin et al.⁶³)

Mean age: 61.75 (SD 12.76)

N = 73

Females = 15 (20.55%)

“Loneliness was measured via the loneliness item from the Center for Epidemiologic Studies Depression (CESD), depression via the CESD (excluding the loneliness item), and stress via the Perceived Stress

Scale. In bivariate analyses, older age (OR per year = 0.958, 95%CI = 0.919–0.998) and being partnered (OR = 0.245, 95%CI = 0.083–0.724) were associated with less loneliness. In the multivariate model, there was an interaction effect between age and partnership (p = 0.0212), where older age was protective against loneliness for non-partnered, but not partnered, patients. Higher loneliness was associated with higher stress (β = 0.484, B = 5.687, 95%CI = 3.195–8.178) and depression (β = 0.618, B = 7.544, 95%CI = 5.241–9.848). Patients who are not partnered and younger may be at increased risk of loneliness after LVAD.”

LO: Loneliness was assessed using an item from the Center for Epidemiologic Studies Depression Scale (CES-D)

Yes

LO: Loneliness (Radloff⁹⁸; Shaffer⁹⁹).

(Löfvenmark et al.⁵⁷)

Mean age: 76 (SD 10.3)

N = 146

Female: 71

NYHA Classification: I—18(15%), II—42 (36%), III 25 (21%), IV 1 (1%)

Lived alone: 62

“Loneliness was reported by 29 (20%) participants. They were more often women (p = 0.001) and younger (p = 0.024). Patients who perceived loneliness had fewer social contacts (p = 0.033), reported lower occurrence of emotional contacts (p = 0.004), were less satisfied with social contacts and close relationships (p = 0.001). Those reporting loneliness had more days hospitalized (p = 0.044), and more readmissions to hospital (p = 0.027), despite not having more severe CHF.”

SI: The Interview Schedule for Social Interaction (ISSI) was used to measure perceived social support.

LO: Measured by one single-item question.

Yes

ISSI: To assess the availability and perceived adequacy for different domains of social relationships. Availability of social integration, availability of attachment, adequacy of social integration, and adequacy of attachment (Henderson et al.¹⁰⁰).

LO: Loneliness.

(Manemann et al.⁴⁷)

Mean age: 73.3

N = 1681

Females: 783 (46.60%)

“A total of 2003 patients returned the survey (response rate, 52%); 1681 patients completed all questions and were retained for analysis. Among these patients (53% men; mean age, 73 years), 19% (n = 312) had moderate perceived social isolation and 6% (n = 108) had high perceived social isolation. After adjustment, patients reporting moderate perceived social isolation did not have an increased risk of death, hospitalizations, or emergency department visits compared with patients reporting low perceived social isolation; however, patients reporting high perceived social isolation had >3.5 times increased risk of death (hazard ratio, 3.74; 95% confidence interval [CI], 1.82–7.70), 68% increased risk of hospitalization (hazard ratio, 1.68; 95% CI, 1.18–2.39), and 57% increased risk of emergency department visits (hazard ratio, 1.57; 95% CI, 1.09–2.27). Compared with patients who self-reported low perceived social isolation, patients reporting moderate perceived social isolation had a 16% increased risk of outpatient visits (rate ratio, 1.16; 95% CI, 1.03–1.31), whereas those reporting high perceived social isolation had a 26% increased risk (rate ratio, 1.26; 95% CI, 1.04–1.53).”

LO: PRO-MIS Social Isolation Short Form 4a v2.0

Yes

LO: Loneliness (Cella et al.,⁷²; Organization⁷³; PROMIS Health Organization,⁷⁴.

(Polikandrioti⁵⁹)

Mean age: 68.6 (SD 7.1)

N = 100 Females: 32 (32%)

NYHA Classification: II—20 (20%), III—36 (36%), IV 44 (44%)

“Of the 100 participants (68% men; mean age, 68.6 ± 7.1 years), 78% reported perceiving social isolation. Factors significantly associated with perceived social isolation were female sex (P = 0.001), New York Heart Association class IV (P = 0.001), stress about HF (P = 0.002), paroxysmal nocturnal dyspnea (P = 0.030), edema in the lower limbs (P = 0.001), report of receiving many medications (P = 0.001), change in body image (P = 0.032), and not following limitations in fluid and sodium intake (P = 0.001). The MFIS total score determined moderate to high levels of fatigue (median, 70 points; range, 21–105 points). Total fatigue was statistically significantly associated with social isolation as perceived by patients (P = 0.001).”

SI: Self-report item of whether they perceived social isolation on a 4-point Likert scale (1 = very much, 2 = enough, 3 = a little, and 4 = not at all).

No

SI Perception of social isolation.

(Allemann et al.⁴⁴)

Mean age: 67.3 (SD 9.8)

N = 1550

Females: 303 (19.5%)

Lived alone: 331 (21.5%)

“Social Isolation Score 5.96 (SD 1.2) Most reported a high level of social support, but 18% did not. In logistic regression, living alone was the greatest predictor of low/medium support. Lower social support for those living alone was associated with poorer perceived health status, having symptoms of depression, and experiencing low perceived control. For those living with someone, lower support was associated with female gender, symptoms of depression and anxiety, and less control. Heart failure status and perceived symptom severity was not related to the outcome.”

SI: MSPSS

Yes

SI: Perception of support from the domains of friends, family, and significant others (Zimet et al.⁶⁵).

(Seo et al.⁴⁵)

Mean age: 57.19 (SD 13.38)

N = 151

Female: 74 (49.3%)

New York Heart Association Classification: II—89 (59.3%), III/IV—55 (36.7%), IV—6 (4.0%)

Lived alone: 38 (25%)

“Structural equation modeling (SEM) showed that cognitive/affective depression was predicted by greater dyspnea and loneliness, whereas somatic depression was predicted by more dyspnea and friend support. Also, greater dyspnea was related to more loneliness and less friend support; less friend support was related to loneliness. Women reported more dyspnea and loneliness.”

SI: MSPSS

LO: Loneliness was measured by one item from the Duke Social Support Index

Yes

SI: Perception of support from the domains of friends, family and significant others (Zimet et al.⁶⁵).

Duke: Network size and contact’s index (Koenig et al.⁸⁰; Landerman et al.⁷⁹).

(Rocha et al.⁶⁴)

Mean age: Cases: 67 (SD 14)

Controls: 70 (SD 9)

Females:Cases: 4 (%)

Controls: 12 (%)

Total sample: 16 (%)

NYHA Classification:Cases: I—3 (21%), II—7 (50%), III—4 (29%)

Control: I—18 (43%), II—19 (45%), III—5 (12%)

T: I—21 (%), II—26 (%), III 9 (%)

Lived alone: 13

Living alone was 35.7% in dropouts.

“The only significant factor associated with dropout was social isolation. Patients who lived alone, without family support, had a significantly greater dropout risk (odds ratio, 12.5; 95% confidence interval, 1.35–11.6)”

LO: Lives alone

SI: Support from family members

No

LO: Loneliness

SI: Family support

(Yang et al.³⁹)

Mean age: 69.67 (SD 8.02)

Females: 143 (47.2%)

N = 303

NYHA Classification:

II—156 (51.5%), III/IV—147 (48.5%)

Lived alone: 20 (6.6%)

Number of comorbidities

<3129 (42.6%) ≥3174 (57.4%)

“Of the 303 patients, 66.7% experienced mild loneliness and 21.8% experienced moderate or severe loneliness. Multiple mediation analysis showed that physical symptoms had a direct effect on loneliness (effect ¼ 0.210; 95% confidence interval (CI) 0.0990.320) and the link between physical symptoms and loneliness through 3 indirect pathways¹: activities of daily living (effect ¼ 0.043; 95% CI 0.006‒0.086), accounting for 20.48% of the total effect²; social isolation (effect ¼ 0.060; 95% CI 0.005‒0.120), accounting for 28.57% of the total effect; and³ activities of daily living and social isolation in series (effect ¼ 0.049; 95% CI 0.024‒0.081), accounting for 23.33% of the total effect. The total mediating effect was 72.38%”

SI: LSNS-6.

LO: UCLA-LS

Yes

SI: Measures perceived social support received by friends and family as a social network index (J. Lubben et al.⁷⁸,).

LO: emotional loneliness, social loneliness, and existential loneliness (Russell⁶⁹,).

(Spaderna et al.³⁵)

Mean age: 52.2

N = 148

Females: 27 (18.20%)

Comorbidity Scores:

Previous heart surgery (n = 126)

40 (27.0%)

Atrial fibrillation (n = 109) 21 (14.2%)

ICD (n = 118) 81 (54.7%)

Lived alone 28 (18.9%)

“Higher depression scores increased the risk of dying (hazard ratio=1.07, 95% confidence interval, 1.01, 1.15, P = 0.032), which was moderated by social isolation scores (significant interaction term; hazard ratio = 0.985, 95% confidence interval, 0.973, 0.998; P = 0.022). These findings were maintained in multivariate models controlling for covariates (P values 0.020–0.039). Actuarial 1-year/5-year survival was best for patients with low depression who were not socially isolated at waitlisting (86% after 1 year, 79% after 5 years). Survival of those who were either depressed, or socially isolated or both, was lower, especially 5 years posttransplant (56%, 60%, and 62%, respectively).”

SI: Composite measure of social isolation defined as frequency of contact with friends or family

No

Network size and contact’s index.

(Sterling et al.³⁶)

Mean age: 76^{71,72,73,74,75,76,77,78,79,80,81,82} *median (IQR)

Females: 306 (44.3%)

LVEF < 50 = 280 (55%)

Comorbidity Scores: 4.0^3,4,5 *median (IQR)

“We assessed 9 SDOH based on the Healthy People 2030 Framework: race, education, income, social isolation, social network, residential poverty, Health Professional Shortage Area, rural residence, and state public health infrastructure. The primary outcome was 30-day all-cause readmission. For each SDOH, we calculated incidence per 1000 person-years and multivariable-adjusted hazard ratios of readmission. Among 690 participants, the median age was 76 years at hospitalization (interquartile range, 71–82), 44.3% were women, 35.5% were Black, 23.5% had low educational attainment, 63.0% had low income, 21.0% had zip code–level poverty, 43.5% resided in Health Professional Shortage Areas, 39.3% lived in states with poor public health infrastructure, 13.1% were socially isolated, 13.3% had poor social networks, and 10.2% lived in rural areas. The 30-day readmission rate was 22.4%. In an unadjusted analysis, only Health Professional Shortage Area was significantly associated with 30-day readmission; in a fully adjusted analysis, none of the 9 SDOH were individually associated with 30-day readmission.”

SI: Composite measure of social isolation defined as frequency of contact with friends or family

No

Network size and contact’s index.

(Zhang et al.³⁸)

Mean age: 77.8 (71.5-84) *median (IQR)

N = 1000

Females: 479 (47.9%)

NYHA Classification: I—57 (7.1%), II—237 (31.1%), III—303 (39.7%), IV—169 (22.1%)

“Of the 303 patients, 66.7% experienced mild loneliness and 21.8% experienced moderate or severe loneliness. Multiple mediation analysis showed that physical symptoms had a direct effect on loneliness (effect ¼ 0.210; 95% confidence interval (CI) 0.0990.320) and the link between physical symptoms and loneliness through 3 indirect pathways¹: activities of daily living (effect ¼ 0.043; 95% CI 0.006‒0.086), accounting for 20.48% of the total effect²; social isolation (effect ¼ 0.060; 95% CI 0.005‒0.120), accounting for 28.57% of the total effect; and³ activities of daily living and social isolation in series (effect ¼ 0.049; 95% CI 0.024‒0.081), accounting for 23.33% of the total effect. The total mediating effect was 72.38%.”

SI: Composite measure of social isolation defined as frequency of contact with friends or family.

No

Network size and contact’s index.

(Kitakata et al.⁴⁰)

Mean age: 73.0

Female: 31 (35.8%)

N = 120

Lived alone: 24

“A Cox proportional hazard model was constructed to elucidate the short-term (180-day) prognostic impact of SI. Overall, 28.3% of participants were at high risk for SI (6-item Lubben Social Network Scale score <12). High‐risk patients had more negative attitudes toward ACP than those without (61.8% versus 80.2%; P = 0.035). The actual performance of ACP conversation in patients with and without high risk were 20.6% and 30.2%, respectively. Regarding preference in end‐of‐life care, “Saying what one wants to tell loved ones” (73.5% versus 90.6%; P = 0.016) and “Spending enough time with family” (58.8% versus 77.9%; P = 0.035) were less important in high‐risk patients. High risk for SI was associated with higher 180‐day risk‐adjusted all‐cause mortality (hazard ratio, 7.89 [95% CI, 1.53–40.75]).”

SI: LSNS-6

Yes

Measures perceived social support received by friends and family as a social network index (J. Lubben et al.⁷⁸,).

(Cené et al.⁴²)

Mean age: 62.6

N = 36457

Females: 36457 (100%)

Lived alone: Reported as Hazard ratios

“Over a median follow‐up of 15.0 years, we analyzed data from 36 457 women, and 2364 (6.5%) incident HF cases occurred; 2510 (6.9%) participants were socially isolated. In multivariable analyses adjusted for sociodemographic, behavioral, clinical, and general health/functioning; socially isolated women had a higher risk of incident HF than nonisolated women (HR, 1.23; 95% CI, 1.08–1.41). Adding depressive symptoms in the model did not change this association (HR, 1.22; 95% CI, 1.07–1.40). Neither race and ethnicity nor age moderated the association between social isolation and incident HF.”

Berkman-Syme Social Network Index.

No

Network size and contacts index with intimate contacts, religion, and community (Berkman and Syme⁷⁵).

(Saito et al.⁴¹)

Mean age: 80 (SD 8)

N = 148

Females: 73 (49%)

Living alone: 28 (19%)

“Among 148 patients with heart failure (80 ± 8 years old, 51% male), 73 (49%) were socially isolated. The patients with social isolation had similar comorbidities compared with those without social isolation. Heart failure rehospitalization occurred within 90 days for 25 patients and the heart failure rehospitalization rate was significantly higher in the social isolation group (p = 0.036). LASSO (least absolute shrinkage and selection operator) regression confirmed that social isolation was one of the strongest predictors of heart failure rehospitalization, showing larger effects than living alone, being unemployed, and other established risk factors.”

SI: LSNS-6

Yes

Measures perceived social support received by friends and family as a social network index (Lubben et al.⁷⁸,).

(Cené et al.⁴³)

Mean age: 56.9 (SD 5.7)

N = 12995

Females: 7147 (55.0%)

“After a median follow-up of 16.9 person-years, 1727 (13.0%) incident HF events occurred. The adjusted hazard of incident HF was greater for those in the higher vs. low social isolation risk group (hazard ratio 1.21, 95% confidence interval 1.08–1.35). Our data suggest that vital exhaustion strongly mediates the association between higher social isolation and incident HF (the percentage change in beta coefficient for higher vs. low social isolation groups after adjusting for vital exhaustion was 36%).”

SI: LSNS-10

Yes

Perception of social engagement and social support with friends, family, and neighbors as a network index (James Earl Lubben,⁷⁷; James E. Lubben⁷⁶,).

(Coyte et al.³⁷)

Mean age: 69.8 (SD 5.4)

N = 3698

Females: 0%

Lived alone: 407 (11.3%)

“Among 3698 participants, 330 developed heart failure. Men with low compared to high frequency of contact with family and friends had an increased risk of incident heart failure [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.15–2.18]; this remained statistically significant after adjustment for social class, behavioral, and biological risk factors. Low compared to high scores for satisfaction with contacts was associated with increased risk of heart failure (adjusted HR = 1.54; 95% CI 1.14–2.07). Lower social relationship scores (combining frequency and satisfaction with contact) were associated with greater risk of incident heart failure (adjusted HR = 1.38, 95% CI 1.02–1.87). Marital status and living alone were not significantly associated with heart failure.”

SI: A Frequency of Contact score.

No

Network size and contact’s index.

(Checa et al.⁵¹)

Mean age: 82 (SD 9.0)

N = 1148

Females: 708 (61.70%)

Comorbidity scores: N = 155 (13%) Charlson Comorbidity Index > 5

NYHA Classification: IV—1148 (100%)

“Data from 1148 New York Heart Association class IV patients were analyzed. Mean (SD) age was 82 (9.0) years, and 61.7% were women. The mean (SD) follow-up was 18.2 (11.9) months. Mortality occurred in 592 patients. Social risk was identified in 63.6% of the patients, and 9.3% acknowledged having social problems. In the adjusted multivariate model, being male (hazard ratio (HR), 1.82; 95% confidence interval [CI], 1.16–2.83), having high dependency on others for basic activities of daily living (HR, 2.16; 95% CI, 1.21–3.85), and presenting with a social problem (HR, 2.46; 95% CI, 1.22–4.97) were related to an increased risk of mortality.”

SI: Gijon’s Social-Familial Evaluation Scale

Yes

SI: Living situation, family situation, economic status, housing, social relationships, and support networks (González et al.¹⁰¹).

(Dickson et al.⁴⁶)

Mean age: 59.63 (SD 15.19)

N = 30

Females: 12 (40%)

NYHA Classification: II—10 (33.3%), III—40 (66.6%)

“Self-care was very poor (standardized mean [SD] Self-care of Heart Failure Index [SCHFI] maintenance, 60.05 [18.12]; SCHFI management, 51.19 [18.98]; SCHFI confidence, 62.64 [8.16]). The overarching qualitative theme was that self-care is influenced by cultural beliefs, including the meaning ascribed to HF, and by social norms. The common belief that HF was inevitable (“all my people have bad hearts”) or attributed to “stress” influenced daily self-care. Spirituality was also linked to self-care (“the doctor may order it but I pray on it”). Cultural beliefs supported some self-care behaviors like medication adherence. Difficulty reconciling cultural preferences (favorite foods) with the salt-restricted diet was evident. The significant relationship of social support and self-care (r = 0.451, P = 0.01) was explicated by the qualitative data. Social norms interfered with willingness to access social support, and “selectivity” in whom individuals confided led to social isolation and confounded self-care practices.”

SI: MSPSS

Yes

Perception of support from the domains of friends, family, and significant others (Zimet et al.⁶⁵,).