Abstract
BACKGROUND: Poor social health is linked to incident cardiovascular disease, but less is known about how loneliness affects health care utilization after an acute myocardial infarction (AMI). OBJECTIVE: Determine the association between loneliness and 30-day emergency department (ED) visit or readmission after AMI hospitalization. RESEARCH DESIGN: The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is a national prospective cohort of 30,239 U.S. adults aged 45 years or older. MEASURES: We examined the association between loneliness and 30-day post-AMI ED visit or readmission. SUBJECTS: Seven hundred forty-nine Medicare fee-for-service beneficiaries in REGARDS were discharged alive after an adjudicated AMI. RESULTS: The mean age was 77 years. Twenty-eight percent self-identified as non-Hispanic Black and 39% as women. Twenty percent reported loneliness. Twenty-nine percent had a 30-day ED visit or readmission. Lonely individuals had 61% increased risk of 30-day ED visit or readmission (RR: 1.61; 95% CI: 1.27-2.04; P <0.001), which remained significant after adjustment for sociodemographic and clinical factors (aRR: 1.48; 95% CI: 1.12-1.95; P =0.006). Stratified analyses demonstrated significant association for those aged 65-74 (aRR 2.48; 95% CI, 1.57-3.91; P <0.001), White adults (aRR: 1.86; 95% CI: 1.35-2.58; P <0.001), and men (aRR: 2.19; 95% CI: 1.59-3.01; P <0.001) but not for those 75+ (aRR: 0.94; 95% CI: 0.63-1.40; P =0.75), Black adults (aRR: 0.89; 95% CI: 0.53-1.49; P =0.660), or women (aRR: 0.81; 95% CI: 0.51-1.30; P =0.380). CONCLUSIONS: Loneliness, even measured years before AMI, was associated with an increased risk of 30-day ED visit or readmission, specifically for those aged 65-74, White participants, and men. These findings may inform discharge strategies to reduce readmissions.