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Prognostic value of a brief loneliness questionnaire for patients with coronary heart disease: Proposal for a
Mitti Blakoe1,2, Anne Vinggaard Christensen1, Pernille Palm1
1Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Insights
A new prediction model, the high-risk loneliness (HiRL) model, can identify coronary heart disease patients at increased risk of one-year mortality due to loneliness. This tool aids clinicians in screening vulnerable patients effectively.
Area of Science:
- Cardiology
- Psychosocial Medicine
- Biostatistics
Background:
- Loneliness significantly increases morbidity and mortality risk in patients with coronary heart disease (CHD).
- Currently, no validated predictive tools exist to identify CHD patients whose mortality risk is elevated due to loneliness.
Purpose of the Study:
- To develop a prediction model for identifying CHD patients at increased risk of one-year all-cause mortality influenced by loneliness.
- To assess the classification performance of the developed prediction model.
- To investigate potential errors in questionnaire responses.
Main Methods:
- A cohort of 7169 CHD patients completed a national survey including loneliness and cohabitation questions.
- National registers provided follow-up data on one-year all-cause mortality.
- Cox-proportional Hazards Ratio was used to evaluate prognostic values, leading to the high-risk loneliness (HiRL) prediction model. Sensitivity, specificity, and likelihood ratio were calculated for performance evaluation.
Main Results:
- Two specific item responses from the loneliness questionnaire significantly predicted one-year mortality (HR=2.24 and HR=2.65).
- The developed HiRL model demonstrated a likelihood ratio of 1.89 for classification performance.
- Evaluation of response errors using a verbal probing technique in a smaller cohort indicated low error rates.
Conclusions:
- A prediction model, the HiRL model, was proposed based on the prognostic value of loneliness questionnaire items for screening CHD patients at high risk.
- The HiRL model serves as a concise screening tool for clinicians to identify CHD patients significantly impacted by loneliness regarding mortality risk.
- Further validation and performance evaluation are recommended before widespread clinical implementation.
Background:
In patients with coronary heart disease (CHD), loneliness is associated with increased risk of morbidity and mortality. No predictive tool is available to detect patients who are influenced by loneliness to a degree that impacts mortality.
Aim:
To: (i) propose a prediction model that detects patients influenced by loneliness to a degree that increases one-year all-cause mortality, (ii) evaluate model classification performance of the prediction model, and (iii) investigate potential questionnaire response errors.
Method:
A cohort of patients with CHD (n = 7169) responded to a national cross-sectional survey, including two questions on loneliness. Information on cohabitation and follow-up information on one-year all-cause mortality were obtained from national registers. Prediction model development was based on the prognostic values of item responses in the questionnaire on loneliness and of cohabitation, evaluated with Cox-proportional Hazards Ratio (HR). Item responses which significantly predicted one-year mortality were included in the high-risk loneliness (HiRL) prediction model. Sensitivity, specificity and likelihood ratio were calculated to evaluate model classification performance. Sources of response errors were evaluated using verbal probing technique in an additional cohort (n = 7). The TRIPOD checklist has been used to ensure transparent reporting.
Results:
Two item responses significantly predicted one-year mortality HR = 2.24 (95%CI = 1.24-4.03) and HR = 2.65 (95%CI = 1.32-5.32) and were thus included in the model. Model classification performance showed a likelihood ratio of 1.89. Response error was evaluated as low.
Conclusion:
Based on the prognostic value in a loneliness questionnaire, a prediction model suitable to screen patients with CHD for high-risk loneliness was suggested.
Relevance To Clinical Practice:
The HiRL prediction model is a short and easy-to-use screening tool that offers clinical staff to identify patients with CHD who are influenced by loneliness to a degree that impacts mortality. However, further evaluation of model performance and questionnaire validation is recommended before integrating the model into clinical practice.
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Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...