Impact of Psychosocial Risk Factors and Social Determinants of Health on Clinical Outcomes in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Abstract

Background and Purpose: Heart failure (HF) outcomes are strongly influenced by social and psychological dimensions beyond traditional clinical risk factors. Depression, social isolation, low socioeconomic status, and limited health literacy have been individually associated with adverse prognosis, yet no comprehensive synthesis has quantified their collective impact. This systematic review and meta-analysis aimed to evaluate the association between psychosocial risk factors and major clinical outcomes in patients with heart failure, emphasizing mortality, hospitalization, and quality-of-life parameters. Methods: A systematic literature search was conducted in PubMed, Embase, PsycINFO, and Scopus up to October 2025. Eligible studies included prospective cohorts and randomized controlled trials assessing at least one psychosocial determinant (e.g., depression, anxiety, social isolation, marital status, education, income level, or health literacy) in adult patients with HF. Primary outcomes were all-cause mortality and HF-related hospitalization; secondary outcomes included quality-of-life (QoL) scores and medication adherence. Pooled relative risks (RR) and standardized mean differences (SMD) were calculated using a random-effects model. Heterogeneity was measured by I², and subgroup analyses explored sex, HF phenotype, and region. Results: Thirty-two studies involving 24,685 participants (mean age 65 ± 10 years; 41% female) met inclusion criteria. Depression increased mortality risk by 45% (RR 1.45, 95% CI 1.28–1.63) and HF hospitalization by 37% (RR 1.37, 95% CI 1.21–1.56). Social isolation was associated with higher mortality (RR 1.29, 95% CI 1.10–1.52), while low socioeconomic status conferred a 32% greater risk of readmission (RR 1.32, 95% CI 1.14–1.54). Patients with strong social support demonstrated significantly higher QoL scores (SMD 0.42, 95% CI 0.18–0.65) and improved medication adherence (RR 1.19, 95% CI 1.05–1.33). Overall heterogeneity was moderate (I² = 48%). Conclusion: Psychosocial and social determinants substantially affect survival, rehospitalization, and quality of life in heart failure. Future research should focus on culturally tailored interventions and longitudinal assessment of modifiable psychosocial risk profiles.