Physician Update: AHA Special Edition
Read more articles from our most relevant research presented at the 2024 AHA Scientific Sessions.
Clinical Heart and Vascular Center
Impact of Kinlessness on Therapeutic Options for Older Patients with Advanced Heart Failure
By Sarah Godfrey, M.D., M.P.H.
Cardiology Fellow
By Maryjane Farr, M.D., M.Sc.
Associate Professor of Internal Medicine
As our population ages, more older adults are finding themselves socially isolated or kinless, with no known or immediate relatives. Social isolation and lack of traditional kin networks have been associated with adverse health outcomes, including long-term facility placement, health care utilization, and all-cause mortality. However, little is known about the prevalence and impact of kinlessness on older patients with advanced heart failure (HF), particularly given the psychosocial requirements for advanced HF therapies.
At #AHA24, we presented our work studying social networks and kinlessness in an older population with advanced HF. Over a 10-year period, 834 adults > 70 years of age were referred to UT Southwestern for advanced HF. In terms of social support, 574 (69%) were married and 734 (88%) had living children, whereas only 28 (3.3%) were kinless. In terms of social isolation, 120 (14%) lived alone. In the overall study cohort, 35 participants (4.2%) received a left ventricular assist device (LVAD) and 23 (2.8%) received a heart transplant (HT). All advanced therapy patients had a living partner or child living within their home county, whereas no kinless patients received either an LVAD or HT.
“[V]ery few (3.3%) older adults referred to an advanced HF center lack a living spouse or child, suggesting that kinless older adults are under-referred for potentially lifesaving therapies.”
We also examined markers of quality of death, as kinlessness and social isolation have been associated with more aggressive end-of-life care. While mortality did not vary by kin status, married adults were more likely to be enrolled in hospice at time of death, and those with children were more likely to die at home – indicating less aggressive care at end of life for those with kin versus those kinless.
In summary, very few (3.3%) older adults referred to an advanced HF center lack a living spouse or child, suggesting that kinless older adults are under-referred for potentially lifesaving therapies. Having a living spouse or child was associated with greater rates of LVAD and HT, as well as rates of hospice and out-of-hospital death. These data may identify important disparities in referral patterns for LVAD or HT, as well as end-of-life care, in older adults with advanced HF who are kinless.
