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. 2025 May 6;14(9):e039885.
doi: 10.1161/JAHA.124.039885. Epub 2025 Apr 25.

Association of Social Disconnection With the Incidence and Prognosis of Atrial Fibrillation: A Multistate Analysis

Yu Qiao  1 , Yuyang Wang  2 , Tingting Ge  3 , Yahong Liu  1 , Yuzhu Chen  4 , Guodong Niu  1   4 , Yifang Yuan  5   6
Affiliations

Association of Social Disconnection With the Incidence and Prognosis of Atrial Fibrillation: A Multistate Analysis

Yu Qiao et al. J Am Heart Assoc. .

Abstract

Background: Social disconnection, including loneliness and social isolation, is associated with increased morbidity and death. However, its impact on the incidence and prognosis of atrial fibrillation (AF) remains inconclusive.

Methods and results: The present prospective cohort study enrolled 418 656 participants without AF and cardiovascular disease from the UK Biobank. A loneliness scale was constructed with 2 domains (loneliness feeling, inability to confide) and social isolation scale was constructed with 3 domains (living alone, lack of social support, and lack of social activity). We used a multistate model to analyze the impacts of the 2 scales on the progression from baseline to incident AF and subsequent major adverse cardiovascular events and further to death. Over a median follow-up of 14.7 years, 25 539 participants developed incident AF, among whom 7283 developed incident major adverse cardiovascular events, and 5165 died. Social isolation and loneliness scales were associated with both a higher incidence and worse prognosis of AF, with hazard ratios per 1-point increase of 1.06 (95% CI, 1.04-1.09) for the loneliness scale and 1.03 (95% CI, 1.02-1.05) for the social isolation scale for incident AF, and 1.12 to 1.14 for the loneliness scale (all P<0.001) and 1.12 to 1.27 for the social isolation scale (all P<0.001) after AF development. Loneliness feeling and living alone may be important contributors.

Conclusions: Loneliness and social isolation were both associated with a higher incidence and a worse prognosis of AF but to different extents. These observations highlight the importance of integrating social connection into the prevention and management of AF.

Keywords: UK Biobank; atrial fibrillation; multistate; social disconnection.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1. Transition pattern of the multistate analysis and numbers (percentages) of participants from baseline to AF, MACEs, and death.
AF indicates atrial fibrillation; and MACE, major adverse cardiovascular event.
Figure 2
Figure 2. Association of loneliness scale (A) and social isolation scales (B) with transitions of AF progression.
Multistate models were used with age as the time scale and adjusted for sex, race, social deprivation level, and living area. AF indicates atrial fibrillation; MACE, major adverse cardiovascular event; and PY, person‐year.
Figure 3
Figure 3. Association of individual social network deprivation factors with transitions of AF progression.
Multistate models were used, with age as the time scale and adjusted for sex, race, social deprivation level, and living area. AF indicates atrial fibrillation; MACE, major adverse cardiovascular event; and PY, person‐year.
See this image and copyright information in PMC

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References

    1. Linz D, Gawalko M, Betz K, Hendriks JM, Lip GYH, Vinter N, Guo Y, Johnsen S. Atrial fibrillation: epidemiology, screening and digital health. Lancet Reg Health Eur. 2024;37:100786. doi: 10.1016/j.lanepe.2023.100786 - DOI - PMC - PubMed
    1. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, Gillum RF, Kim YH, McAnulty JH Jr, Zheng ZJ, et al. Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation. 2014;129:837–847. doi: 10.1161/CIRCULATIONAHA.113.005119 - DOI - PMC - PubMed
    1. Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and Management of Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2023;149:e1–e156. doi: 10.1161/CIR.0000000000001193 - DOI - PMC - PubMed
    1. Na PJ, Jeste DV, Pietrzak RH. Social disconnection as a global behavioral epidemic‐a call to action about a major health risk factor. JAMA Psychiatry. 2023;80:101–102. doi: 10.1001/jamapsychiatry.2022.4162 - DOI - PMC - PubMed
    1. National Academies of Sciences, Medicine, Division of Behavioral, Social Sciences, Medicine Division, Board on Behavioral, Sensory Sciences, Board on Health Sciences Policy, Committee on the Health, Medical Dimensions of Social Isolation, Loneliness in Older Adults . Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. National Academies Press (US); 2020. - PubMed

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