Why lonely heart patients are at a greater risk

: A new study, presented at 'Heart Failure 2019', has found that less than 10 per cent of lonely patients with heart failure follow the recommendation on salt and fluid restriction, daily weighing and physical activity.

"Loneliness is the most important predictor of whether patients adopt the advice or not," said senior author Professor Beata Jankowska-Polaska, Wroclaw Medical University.

"Patients who are alone do worse in all areas. Family members have a central role in helping patients comply, particularly older patients, by providing emotional support, practical assistance, and advice," added Jankowska-Polaska.

Failure to adhere to lifestyle recommendations or regularly take medications contributes to worsening heart failure symptoms and a raised risk of hospitalisation. Breathlessness, swollen ankles and legs, and tiredness occur because the heart can no longer pump effectively. Fluid backs up in the lungs and is retained in parts of the body, and the muscles receive insufficient blood and oxygen.

Daily weighing flags up worsening fluid retention, while salt and fluid restrictions help keep fluid retention under control. Physical activity improves energy levels and quality of life.

The study examined adherence to these four recommendations in 475 patients with chronic heart failure using the Revised Heart Failure Compliance Scale.

Following the recommendations was defined as "every day" or "three times a week" for weighing and "most of the time" or "all the time" for salt, fluid, and exercise. Just 7 per cent of patients followed all four non-drug recommendations. Compliance with medication and regular check-ups was higher, at 58 per cent.

Nearly 48 per cent did no physical activity, and 19 per cent very rarely exercised. Some 25 per cent and 17 per cent never or very rarely adhered to fluid restrictions, respectively.

While 13 per cent never and 22 per cent very rarely restricted salt intake. More than half of patients (54 per cent) weighed themselves less than once a week, and 17 per cent did it once a week.

"It is worrying that one in ten patients observed all of the lifestyle advice," said Professor Jankowska-Polaska. "We also found that women were less compliant than men, and patients over 65 had poorer scores than younger patients."

Multivariate analysis showed that loneliness, a higher number of comorbidities, and more physically limiting heart failure were independent predictors of non-compliance to the four recommendations.

Doctors and nurses need to encourage better self-care in their patients with heart failure, said Professor Jankowska-Polaska.

"Patients need clear written instructions on how to exercise for example, while text messages or phone calls can be used as reminders. It's important to check that patients understand the advice, tailor the recommendations, and assess adherence at every visit," she said.