title: Prognostic importance of emotional support for elderly patients hospitalized with heart failure.
abstract: 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.
  
  
  RESULTS
  We reviewed the medical records of 292 subjects aged > or =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.
  
  
  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.
authors.affiliation: Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA. harlan.krumholz@Yale.edu
authors.forename: H M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: J
authors.initials: J
authors.lastname: Butler
authors.forename: J
authors.initials: J
authors.lastname: Miller
authors.forename: V
authors.initials: V
authors.lastname: Vaccarino
authors.forename: C S
authors.initials: CS
authors.lastname: Williams
authors.forename: C F
authors.initials: CF
authors.lastname: Mendes de Leon
authors.forename: T E
authors.initials: TE
authors.lastname: Seeman
authors.forename: S V
authors.initials: SV
authors.lastname: Kasl
authors.forename: L F
authors.initials: LF
authors.lastname: Berkman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004644:Emotions / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012737:Sex Factors; D013315:Stress, Psychological / Q000503:physiopathology