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Social Connectedness and Successful Nursing Home Discharge After Heart Failure Hospitalization
Andrew L Chen1, Blythe G Chen2, Lan Jiang3
1The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Journal of the American Medical Directors Association
|August 25, 2025
Summary
Socially connected veterans with heart failure (HF) discharged to skilled nursing facilities (SNFs) had higher rates of successful community discharge. Low social connectedness may indicate complex care needs hindering home transitions.
Area of Science:
- Gerontology
- Public Health
- Cardiology
Background:
- Social connectedness is linked to better health outcomes.
- Patients discharged to skilled nursing facilities (SNFs) after heart failure (HF) hospitalization have high readmission risks.
- The impact of social connectedness on successful SNF discharge for HF patients is unknown.
Purpose of the Study:
- To determine the association between social connectedness and successful discharge from postacute SNF care among veterans with HF.
- To quantify the relationship between social connectedness and discharge outcomes in a veteran population.
Main Methods:
- Retrospective cohort study of veterans with HF discharged to SNFs (January 2011-June 2019).
- Primary outcome: successful discharge (community discharge within 90 days and survival 30 days post-discharge without rehospitalization/institutionalization).
- Social connectedness measured using the Social Connectedness Index (SCI), dichotomized as low (0-4) or high (5).
Main Results:
- 29,725 veterans were included in the analysis.
- Higher social connectedness (SCI=5) was associated with a greater likelihood of successful discharge (adjusted relative risk: 1.21; 95% CI: 1.13-1.31).
- This association persisted in subgroups with and without Alzheimer's disease and related dementias (ADRD).
Conclusions:
- Veterans with HF experiencing greater social connectedness in SNFs demonstrated higher successful discharge rates.
- Low social connectedness may signal unmet care needs complicating transitions to home.
- Measuring social isolation could aid in identifying patients suitable for successful discharge.
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