Thank you to Setareh Raygani, MS, AGNP-C and Linda Park, PhD, MS, FNP-BC, FAAN for authoring this important article on loneliness and cardiovascular disease.

The Growing Concern of Loneliness and Cardiovascular Disease

Loneliness and social isolation have recently been recognized as significant factors influencing the prognosis and management of cardiovascular disease (CVD), with profound effects on mortality, morbidity, and health behaviors. ^{1, 2} As frontline healthcare providers, cardiovascular nurses are uniquely positioned to identify and mitigate the impact of loneliness. Furthermore, understanding the effects of loneliness in patients with CVD is crucial in addressing the physical, mental, and social impact.

The Physical Toll of Loneliness and Cardiovascular Disease

Research has shown that loneliness can lead to adverse physical health outcomes — more than one-third of US adults over 45 and older report feeling lonely. ³ Adults experiencing poor social relationships, whether from social isolation or loneliness, have a 29% increased risk of incident coronary heart disease and a 32% increased risk of stroke.¹ Moreover, in adults living with heart failure, there is a four times increased risk of death and a 68% increased risk of hospitalization.²

There is significant evidence that loneliness and social isolation are major public health risks, especially for individuals living with CVD. Nurses should be on the lookout for possible signs and symptoms of loneliness and social isolation such as poor sleep, impaired executive function, and poor cardiovascular health and self-care.^3,4

Impact of Loneliness on Mental Health  

Loneliness has a profound effect on mental health. While everyone experiences loneliness at one point or another, it has also been closely linked to other mental health challenges such as depression, anxiety, and accelerated cognitive decline.^3,4

Through their interactions and support, nurses are pivotal in promoting a culture of social connection. Nurses can incorporate social history into health assessments and work with an interdisciplinary team to develop care plans to reduce loneliness by addressing patients’ emotional and mental well-being.

Additionally, nurses can assess the social factors that serve as barriers to obtaining the needed care and support. For example, social environmental factors such as transportation, housing, long-term care settings, and rural vs. urban geographic locations can contribute to loneliness and social isolation.³

Nurse-Driven Interventions to Address Loneliness

Nurses can proactively engage with patients and screen for signs of loneliness and social isolation to help refer patients to available resources and programs. Some useful, commonly used screening tools are the Berkman-Syme Social Network Index for measuring social isolation and the three-item UCLA Loneliness Scale for measuring loneliness.³

Many and strategies may be nurse-driven. Nurses can encourage engagement with local community activities (e.g., gym membership with programs for seniors, volunteer organizations), and social contact wth friends and family. One helpful resource for nurses to be aware of includes the AARP Friendly Voice Program, where trained volunteers call individuals experiencing social isolation or loneliness.⁵ In addition, referrals can be made to local Area Agencies on Aging (AAA) to provide services for older adults living at home.⁵ Nurses can also lead interventions (e.g., social cognitive behavioral therapy) and facilitate social support groups to reduce loneliness and social isolation.⁶ Similarly, nurses can promote telehealth and social media as helpful tools for maintaining medical and social contacts for homebound patients or individuals who live in rural areas.⁷ Regular contact through text messaging, phone calls, and email can help maintain social connection. Nurses can also be leaders in research to develop, implement, and evaluate theory-driven interventions to improve loneliness and social isolation to improve cardiovascular and brain health.³

The Critical Role of Nurses in Tackling Loneliness and Cardiovascular Disease

Overall, cardiovascular nurses play a crucial role in assessing and addressing patients’ experiences of loneliness. The impact of loneliness and social isolation on physical and mental health and its burden on those living with CVD is undisputed. This is an emerging area of research, but by recognizing and intervening with current evidence, nurses can enhance patient outcomes and quality of life.

Related Resources

• Podcast Episode: Mental Health and Cardiovascular Disease

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References

1 Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102(13):1009-1016. doi:10.1136/heartjnl-2015-308790.

2 Manemann SM, Chamberlain AM, Roger VL, et al. Perceived social isolation and outcomes in patients with heart failure. J Am Heart Assoc. 2018;7(11).  doi:10.1161/JAHA.117.008069.

3 National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Health and Medicine Division; Board on Behavioral, Cognitive, and Sensory Sciences; Board on Health Sciences Policy; Committee on the Health and Medical Dimensions of Social Isolation and Loneliness in Older Adults. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington (DC): National Academies Press (US); February 27, 2020.

4 Finley AJ, Schaefer SM. Affective Neuroscience of Loneliness: Potential Mechanisms underlying the Association between Perceived Social Isolation, Health, and Well-Being. J Psychiatr Brain Sci. 2022;7(6):e220011. doi:10.20900/jpbs.20220011

5 Galvez-Hernandez P, González-de Paz L, Muntaner C. Primary care-based interventions addressing social isolation and loneliness in older people: a scoping review. BMJ Open. 2022;12(2):e057729. Published 2022 Feb 4. doi:10.1136/bmjopen-2021-057729

6 Dickens AP, Richards SH, Greaves CJ, Campbell JL. Interventions targeting social isolation in older people: a systematic review. BMC Public Health. 2011;11:647. Published 2011 Aug 15. doi:10.1186/1471-2458-11-647

7 Holt-Lunstad J, Smith TB. Loneliness and social isolation as risk factors for CVD: implications for evidence-based patient care and scientific inquiry. Heart. 2016;102(13):987-989. doi:10.1136/heartjnl-2015-309242