Loneliness as an independent predictor of long-term stroke risk in atrial fibrillation patients: a UK biobank cohort analysis
B O H A N Li, Q I N G L Zhang, M A N Y U N Tang, Y A N Liu, Y U E Wu, G U O L LiAbstract
Background
Atrial fibrillation (AF) is associated with a substantially increased risk of stroke, yet traditional risk factors do not fully explain the observed heterogeneity in this risk.
Purpose
Using data from the UK Biobank, we prospectively investigated the associations of loneliness and social isolation scales with incident stroke among individuals with AF and compared the relative contributions of loneliness and social isolation.
Methods
We used data from the UK Biobank to identify participants with atrial fibrillation at baseline and no prior stroke. We assessed loneliness and social isolation as key psychosocial factors and examined their associations with long-term stroke risk using multivariable Cox proportional hazards models. Fine–Gray competing risk models were additionally applied for sensitivity analyses.
Results
Among 7,851 participants with atrial fibrillation at baseline, 984 incident strokes were recorded over a mean follow-up of 13.23 years. In multivariable Cox proportional hazards models adjusted for age, sex, body mass index, blood pressure, blood lipids, socioeconomic deprivation, smoking, and comorbidities, higher levels of loneliness were associated with an increased risk of stroke. Compared with participants reporting no loneliness (score 0), the fully adjusted hazard ratios (95% confidence intervals) were 1.13 (0.95–1.36) for a loneliness score of 1 and 1.39 (1.01–1.90) for a loneliness score of 2, with a significant trend across categories (P for trend < 0.001). In contrast, social isolation was not significantly associated with incident stroke. These findings were robust when loneliness was modelled as a continuous variable and were consistent across multiple sensitivity analyses.
Conclusion
Our findings indicate that loneliness is associated with an increased risk of stroke in individuals with atrial fibrillation. Incorporating brief psychosocial screening into routine care may help identify patients who could benefit from targeted interventions alongside standard anticoagulation therapy, thereby reducing stroke burden and prognostic disparities.Association between loneliness and incid