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Original research
Significantly increased risk of all-cause mortality among cardiac patients feeling lonely
  1. Anne Vinggaard Christensen1,
  2. Knud Juel2,
  3. Ola Ekholm2,
  4. Lars Thrysøe3,
  5. Charlotte Brun Thorup4,
  6. Britt Borregaard5,
  7. Rikke Elmose Mols6,
  8. Trine Bernholdt Rasmussen7,
  9. Selina Kikkenborg Berg1,2,8
  1. 1 Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  2. 2 National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
  3. 3 Department of Cardiology, Odense University Hospital, Odense, Denmark
  4. 4 Department of Cardiology and Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
  5. 5 Cardiothoracic and Vascular Department, Odense University Hospital, Odense, Denmark
  6. 6 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
  7. 7 Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
  8. 8 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Anne Vinggaard Christensen, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; anne.vinggaard.christensen{at}


Objective To explore whether living alone and loneliness 1) are associated with poor patient-reported outcomes at hospital discharge and 2) predict cardiac events and mortality 1 year after hospital discharge in women and men with ischaemic heart disease, arrhythmia, heart failure or heart valve disease.

Methods A national cross-sectional survey including patients with known cardiac disease at hospital discharge combined with national register data at baseline and 1-year follow-up. Loneliness was evaluated using one self-reported question, and information on cohabitation was available from national registers. Patient-reported outcomes were Short Form-12, Hospital Anxiety and Depression Scale and HeartQoL. Clinical outcomes were 1-year cardiac events (myocardial infarction, stroke, cardiac arrest, ventricular tachycardia/fibrillation) and all-cause mortality from national registers.

Results A total of 13 443 patients (53%) with ischaemic heart disease, arrhythmia, heart failure or heart valve disease completed the survey. Of these, 70% were male, and mean age was 66.1 among women and 64.9 among men. Across cardiac diagnoses, loneliness was associated with significantly poorer patient-reported outcomes in men and women. Loneliness predicted all-cause mortality among women and men (HR 2.92 (95% CI 1.55 to 5.49) and HR 2.14 (95% CI 1.43 to 3.22), respectively). Living alone predicted cardiac events in men only (HR 1.39 (95% CI 1.05 to 1.85)).

Conclusions A strong association between loneliness and poor patient-reported outcomes and 1-year mortality was found in both men and women across cardiac diagnoses. The results suggest that loneliness should be a priority for public health initiatives, and should also be included in clinical risk assessment in cardiac patients.

  • epidemiology
  • coronary artery disease
  • heart failure
  • valvular heart disease

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  • Contributors SKB conceived the overall idea for the DenHeart study and all authors designed the study. AVC performed the statistical analyses and wrote the first draft of the manuscript. All revised the manuscript critically. All have given their final approval of the version to be published.

  • Funding This work was supported by Helsefonden; the Danish heart centres; the Novo Nordisk Foundation, Familien Hede Nielsens Fond and The Danish Heart Association.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval According to Danish legislation, surveys should only be approved by the Danish Data Protection Agency (2007-58-0015/30-0937). Use of register data were permitted by The Danish National Board of Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.