From the Department of Epidemiology and Public Health (V.V., H.K., S.K.,
C.W.), the Department of Internal Medicine, Section of Cardiovascular Medicine
(H.K., J.M.), Yale University School of Medicine, New Haven, Connecticut; the
Yale-New Haven Hospital Center for Outcomes Research and Evaluation (H.K.),
New Haven, Connecticut; the Connecticut Peer Review Organization, Middletown,
Connecticut (H.K.); the Department of Medicine, Division of Cardiology,
Vanderbilt University School of Medicine (J.B.), Nashville, Tennessee; Rush
Institute on Aging (C.M.), Chicago, Illinois; the Ethel Percy Andrus
Gerontology Center (T.S.), University of Southern California, Los Angeles,
California; and the Department of Health and Social Behavior (L.B.), Harvard
School of Public Health, Boston, Massachusetts.
Background—Several studies have
indicated that a variety of social relationships are important
predictors of morbidity and mortality in patients with coronary
artery disease, but little attention has been focused on the prognostic
importance of these factors in the growing population of elderly
patients with heart failure. To address this issue, we sought to
determine whether emotional support is associated with fatal and
nonfatal cardiovascular events in elderly patients
hospitalized with heart failure.
Methods and Results—We reviewed the medical records of 292
subjects aged
Conclusions—Among elderly patients hospitalized with clinical
heart failure, the absence of emotional support, measured before
admission, is a strong, independent predictor of the occurrence of
fatal and nonfatal cardiovascular events in the year
after admission. In this cohort, the association is restricted to
women.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Prognostic Importance of Emotional Support for Elderly Patients Hospitalized With Heart Failure
65 years who were hospitalized with clinical heart
failure and were part of the New Haven, Conn, cohort of the Established
Population for the Epidemiologic Study of the Elderly, a longitudinal,
community-based study of aging that included a comprehensive assessment
of psychosocial support. In the unadjusted analysis, lack of
emotional support was significantly associated with the 1-year risk of
fatal and nonfatal cardiovascular outcomes [odds
ratio, 2.4; 95% confidence interval, 1.1 to 4.9]. After adjustment
for demographic factors, clinical severity, comorbidity and functional
status, social ties, and instrumental support, the absence of emotional
support remained associated with a significantly higher risk (odds
ratio, 3.2; 95% confidence interval, 1.4 to 7.8). The test for
interaction between emotional support and sex was significant
(P=.01). In the fully adjusted model, the odds ratio for
women was 8.2 (95% confidence interval, 2.5 to 27.2) compared with 1.0
(95% confidence interval, 0.3 to 3.3) for men.
Key Words: heart failure • elderly • emotional support
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