Joint association of loneliness and anxiety on atrial fibrillation risk

Population growth and aging contribute to the increasing incidence of atrial fibrillation (AF), emphasizing the significance of social determinants of health such as social support (including social networks). In this context, there was a theoretical framework linking the absence of social networks (social isolation or loneliness) with AF, influenced by psychological factors, but lacks conclusive evidence.

The purpose of this study was to evaluate the association between social isolation or loneliness and AF, with a focus on the joint effects of them with psychological distress (depression or loneliness).

This cohort study included 319,901 healthy participants from the UK Biobank Study with complete loneliness and social isolation measurements. Cox proportional hazards regression was used to assess the associations of loneliness/social isolation and AF while considering the joint effect with depression and anxiety.

Loneliness (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.03-1.26), especially persistent loneliness (HR 2.11, 95% CI 1.08-4.11), was independently associated with AF. However, no evidence of association between social isolation and AF has been found (HR 1.03, 95% CI 0.96-1.09). Lonely individuals combined with depression (HR 1.42, 95% CI 1.05-1.92) or anxiety (HR 2.30, 95% CI 1.59-3.33) had increased AF risks. Furthermore, loneliness and anxiety have a significant interaction effect on AF risk (P_interaction <.001).

Loneliness, especially longitudinal loneliness, increases AF risk. Furthermore, loneliness and anxiety synergistically increase AF risk. Focusing on anxious lonely individuals probably could provide additional insight into early prevention strategies of AF.