Social Network as a Predictor of Hospital Readmission and Mortality Among Older Patients With Heart Failure

doi:10.1016/j.cardfail.2006.06.471

Journal of Cardiac Failure

Volume 12, Issue 8, October 2006, Pages 621-627

https://doi.org/10.1016/j.cardfail.2006.06.471 Get rights and content

Abstract

Background

This study examines the relationship between social network and hospital readmission and mortality in older patients with heart failure.

Methods and Results

Prospective study conducted with 371 patients, age 65 and older, admitted for heart failure–related emergencies at 4 Spanish hospitals. Social network was measured at baseline with a 4-item questionnaire that ascertained whether subjects were married, lived with another person(s), saw or had telephone contact with family members daily or almost daily, and were at home alone for less than 2 hours per day. Social network was deemed “high” where all 4 items were present, “moderate” where 3 were present, and “low” where 2 or fewer were present. Analyses were performed using Cox models, and adjusted for the main confounders. A total of 55% of patients had high or moderate social networks. During a median follow-up of 6.5 months, 135 (36.4%) patients underwent a first emergency rehospitalization and 68 (18.3%) died. Compared with patients with high social network, hospital readmission was more frequent among those who had moderate (hazard ratio [HR] 1.87; 95% confidence interval [CI] 1.06–3.29; P < .05) and low social networks (HR 1.98; 95% CI 1.07–3.68; P < .05). This relationship showed a positive dose-response (p for linear trend 0.042). The magnitude of this association was comparable to that of other important predictors of readmission, such as previous hospitalization. No relationship was observed between social network and death.

Conclusion

A very simple questionnaire measuring social network can identify patients with a higher short-term risk of hospital readmission.

Section snippets

Study Design and Subjects

A prospective study was conducted on 433 patients admitted for HF-related emergencies at 4 Spanish hospitals. The study included patients of both sexes age 65 years and older, with diagnosis (principal or secondary) of suspected HF. Suspected diagnosis was made in cases where patients simultaneously presented with the following symptoms and signs:⁹ complaint of shortness of breath or fatigue; and alveolar edema, interstitial edema, or signs of pulmonary vascular redistribution on emergency

Study Sample

Of the 433 patients enrolled, information on 1 or more of the baseline variables was lacking in 23 subjects. In addition, 39 (9%) subjects were lost to follow-up of hospital readmission and 24 (5.5%) to follow-up of mortality. Consequently, final analyses were performed on 371 (85.7%) patients for whom there was complete information. The characteristics of the study subjects are presented in Table 1.

Median follow-up of patients was 6.4 months for hospital readmission and 6.6 months for death.

Discussion

Our results show that the greater the degree of social isolation, the higher the frequency of hospital readmission in patients with HF. The influence of a low social network on hospital readmission is comparable to that exerted by other important biomedical factors, and is not explained by a good number of biomedical and psychosocial variables. However, no relationship was observed between social network and mortality in HF patients.

References (32)

A. Rozanski et al.
The epidemiology, pathophysiology, and management of psychosocial risk factors in clinical practice. The emerging field of behavioral cardiology
J Am Coll Cardiol
(2005)
T.E. Seeman
Social ties and health: the benefits of social integration
Ann Epidemiol
(1996)
T.A. Murberg et al.
Social relationships and mortality in patients with congestive heart failure
J Psychosom Res
(2001)
M.H. Chin et al.
Correlates of early hospital readmission or death in patients with congestive heart failure
Am J Cardiol
(1997)
M.E. Charlson et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chron Dis
(1987)
J.A. Yesavage et al.
Development and validation of a geriatric depression rating scale: a preliminary report
J Psychiatr Res
(1983)
S.S. Knox et al.
Social isolation and cardiovascular disease: an atherosclerotic pathway?
Psychoneuroendocrinology
(1998)
K.E. Joynt et al.
Why is depression bad for the failing heart? A review of the mechanistic relationship between depression and heart failure
J Card Fail
(2004)
L.S. Evangelista et al.
Relationship between psychosocial variables and compliance in patients with heart failure
Heart Lung
(2001)
H. Litwin
Social network type and health status in a national sample of elderly Israelis
Soc Sci Med
(1998)

T.A. Glass et al.

Beyond single indicators of social networks: a LISREL analysis of social ties among the elderly

Soc Sci Med

(1997)

L.F. Berkman et al.

Social integration, social networks, social support, and health

S.A. Stansfeld

Social support and social cohesion

P.M. Eng et al.

Social ties and change in social ties in relation to subsequent total and cause-specific mortality and coronary heart disease incidence in men

Am J Epidemiol

(2002)

F. Mookadam et al.

Social support and its relationship to morbidity and mortality after acute myocardial infarction: systematic overview

Arch Intern Med

(2004)

H.M. Krumholz et al.

Prognostic importance of emotional support for elderly patients hospitalized with heart failure

Circulation

(1998)

Cited by (128)

Association of Psychosocial Risk Factors and Outcomes in Heart Failure: Does COVID-19 Affect Outcomes?
2023, Current Problems in Cardiology
Psychosocial risk factors (PSRFs) have emerged as crucial nontraditional risk factors affecting outcomes in patients with heart failure (HF). There is a paucity of data studying these risk factors in HF nationally. Additionally, whether the COVID-19 pandemic impacted outcomes remains unexplored, given the increased psychosocial risk during these times. Our objective is to assess the impact of PSRFs on the outcomes of HF and their comparison across non-COVID-19 and COVID-19 eras. Patients with a diagnosis of HF were selected using the 2019-2020 Nationwide Readmissions Database. Two cohorts were created based on the presence or absence of PSRFs and compared across non-COVID-19 and COVID-19 eras. We examined the association using hierarchical multivariable logistic regression models. A total of 305,955 patients were included, of which 175,348 (57%) had PSRFs. Patients with PSRFs were younger, less likely to be female, and had a higher prevalence of cardiovascular risk factors. All-cause readmissions were higher in patients with PSRFs in both the eras. All-cause mortality [odds ratio, OR 1.15 (1.04-1.27), P = 0.005] and composite of MACE [OR 1.11 (1.06-1.16), P < 0.001] were higher in patients in the non-COVID-19 era. Compared to 2019, patients with PSRFs and HF in 2020 had significantly higher all-cause mortality [OR 1.13 (1.03-1.24), P = 0.009]; however, the composite of MACE was comparable [OR 1.04 (1.00-1.09), P = 0.03]. In conclusion, the presence of PSRFs in patients with HF is associated with a significant increase in all-cause readmissions in COVID-19 and non-COVID-19 eras. The worse outcomes evident in the COVID-19 era highlights the importance of multidisciplinary care in this vulnerable population.
High-Value Care Outcomes of Meningiomas
2023, Neurosurgery Clinics of North America
Substance Use Disorders Are Independently Associated with Hospital Readmission Among Patients with Brain Tumors
2022, World Neurosurgery
Research on the effects of substance use disorders (SUDs) on postoperative outcomes within neurosurgical oncology has been limited. Therefore, the present study sought to quantify the effect of having a SUD on hospital length of stay, postoperative complication incidence, discharge disposition, hospital charges, 90-day readmission rates, and 90-day mortality rates following brain tumor surgery.
The present study used data from patients who received surgical resection for brain tumor at a single institution between January 1, 2017, and December 31, 2019. The Mann–Whitney U test was used for bivariate analysis of continuous variables and Fisher exact test was used for bivariate analysis of categorical variables. Multivariate analysis was conducted using logistic regression models.
Our study cohort included a total of 2519 patients, 124 (4.9%) of whom had at least 1 SUD. More specifically, 90 (3.6%) patients had an alcohol use disorder, 27 (1.1%) had a cannabis use disorder, and 12 (0.5%) had an opioid use disorder. On bivariate analysis, 90-day hospital readmission was the only postoperative outcome significantly associated with a SUD (odds ratio 2.21, P = 0.0011). When controlling for patient age, sex, race, marital status, insurance, brain tumor diagnosis, 5-factor modified frailty index score, American Society of Anesthesiologists score, and surgery number, SUDs remained significantly and independently associated with 90-day readmission (odds ratio 1.82, P = 0.013).
In patients with brain tumor, SUDs significantly and independently predict 90-day hospital readmission after surgery. Targeted management of patients with SUDs before and after surgery can optimize patient outcomes and improve the provision of high-value neurosurgical care.
Patient-Reported Outcome Measures Modestly Enhance Prediction of Readmission in Patients with Cirrhosis
2022, Clinical Gastroenterology and Hepatology
Patients with cirrhosis have high rates of hospital readmission, but prediction models are suboptimal and have not included important patient-reported outcome measures (PROMs). In a large prospective cohort, we examined the impact of PROMs on prediction of 30-day readmissions.
We performed a prospective cohort study of adults with cirrhosis admitted to a tertiary center between June 2014 and March 2020. We collected clinical information, socioeconomic status, and PROMs addressing functional status and quality of life. We used hierarchical competing risk time-to-event analysis to examine the impact of PROMs on readmission prediction.
A total of 654 patients were discharged alive, and 247 (38%) were readmitted within 30 days. Readmission was independently associated with cerebrovascular disease, ascites, prior hospital admission, admission via the emergency department, lower albumin, higher Model for End-Stage Liver Disease, discharge with public transportation, and impaired basic activities of daily living and quality-of-life activity domain. Reduced readmission was associated with cancer, admission for infection, children at home, and impaired emotional function. Compared with a model including only clinical variables, addition of functional status and quality-of-life variables improved the area under the receiver-operating characteristic curve from 0.72 to 0.73 and 0.75, with net reclassification indices of 0.22 and 0.18, respectively. Socioeconomic variables did not significantly improve prediction compared with clinical variables alone. Compared with a model using electronically available variables only, no models improved prediction when examined with integrated discrimination improvement.
PROMs may marginally add to the prediction of 30-day readmissions for patients with cirrhosis. Poor social support and disability are associated with readmissions and may be high-yield targets for future interventions.
Predicting High-Value Care Outcomes After Surgery for Non–Skull Base Meningiomas
2022, World Neurosurgery
A need exists to better understand the prognostic factors that influence high-value care outcomes after meningioma surgery. The goal of the present study was to develop predictive models to determine the patients at risk of experiencing an extended hospital length of stay (LOS), nonroutine discharge disposition, and/or a 90-day hospital readmission after non–skull base meningioma resection.
In the present study, we analyzed the data from 396 patients who had undergone surgical resection of non–skull base meningiomas at a single institution between January 1, 2005 and December 31, 2020. The Mann-Whitney U test was used for bivariate analysis of the continuous variables and the Fisher exact test for bivariate analysis of the categorical variables. A multivariate analysis was conducted using logistic regression models.
Most patients had had a falcine or parasagittal meningioma (66.2%), with the remainder having convexity (31.8%) or intraventricular (2.0%) tumors. Nonelective surgery (P < 0.0001) and an increased tumor volume (P = 0.0022) were significantly associated with a LOS >4 days on multivariate analysis. The independent predictors of a nonroutine discharge disposition included male sex (P = 0.0090), nonmarried status (P = 0.024), nonelective surgery (P = 0.0067), tumor location within the parasagittal or intraventricular region (P = 0.0084), and an increased modified frailty index score (P = 0.039). Hospital readmission within 90 days was independently associated with nonprivate insurance (P = 0.010) and nonmarried status (P = 0.0081). Three models predicting for a prolonged LOS, nonroutine discharge disposition, and 90-day readmission were implemented in the form of an open-access, online calculator (available at: https://neurooncsurgery3.shinyapps.io/non_skull_base_meningiomas/).
After external validation, our open-access, online calculator could be useful for assessing the likelihood of adverse postoperative outcomes for patients undergoing surgery of non–skull base meningioma.
Coping resources of heart failure patients – a comparison with cancer patients and individuals having no chronic condition results from the esther study
2020, Heart and Lung
Heart failure (HF) and cancer patients share similarities in symptom burden and depression prevalence. Coping resources, such as optimism have been associated with improved health-related quality of life (HRQoL) and mental health.
To investigate a wide range of resources in a large population-based sample of HF patients; to compare resources between three groups: HF patients, cancer patients, and individuals having no chronic condition.
This cross-sectional analysis was performed among n = 2761 subjects who participated in home visits during the 11-year follow-up of the epidemiological ESTHER study. Resources were assessed by trained medical doctors through a questionnaire that lists 26 items. One-way analyses of covariance (ANCOVAs) controlled for sociodemographic variables and depression were performed to compare resources between groups.
Family and self-efficacy were the most frequently reported resources in all groups. HF patients reported optimism significantly less frequently as a resource in comparison to cancer patients (p=.031). HF patients showed significantly lower levels of resource factor 3 (positive attitude), compared to cancer patients (p=.006), and not chronically ill participants (p=.037).
Family and self-efficacy seem to be the most important resources, regardless of diagnosis. HF patients appear to have significantly lower levels of resources concerning positive attitude, compared to cancer patients, and not chronically ill individuals. We suggest the development of psychosocial interventions to enhance optimism in HF.

View all citing articles on Scopus

: Supported by FIS grant 00/0035, by an unrestricted educational contract with Lilly Pharmaceuticals, Spain, and by ISCIII (network C03/09 and network G03/065). The sponsors had no role in study concept and design, subject recruitment, acquisition of data, data analysis, writing of the manuscript, or in the decision to submit the article for publication.

View full text

Clinical InvestigationSocial Network as a Predictor of Hospital Readmission and Mortality Among Older Patients With Heart Failure

Abstract

Background

Methods and Results

Conclusion

Section snippets

Study Design and Subjects

Study Sample

Discussion

J Am Coll Cardiol

Ann Epidemiol

J Psychosom Res

Am J Cardiol

J Chron Dis

J Psychiatr Res

Psychoneuroendocrinology

J Card Fail

Heart Lung

Soc Sci Med

Soc Sci Med

Social integration, social networks, social support, and health

Social support and social cohesion

Social ties and change in social ties in relation to subsequent total and cause-specific mortality and coronary heart disease incidence in men

Am J Epidemiol

Social support and its relationship to morbidity and mortality after acute myocardial infarction: systematic overview

Arch Intern Med

Prognostic importance of emotional support for elderly patients hospitalized with heart failure

Circulation

Clinical Investigation
Social Network as a Predictor of Hospital Readmission and Mortality Among Older Patients With Heart Failure