The following are key points to remember from a review about the negative impact kinlessness can have on older adults with advanced heart failure (HF) and potential solutions to the disparity of care:

1. Negative social health concepts include kinlessness (lack of partner or children), social isolation (physical separation from others and lack of relationships), and loneliness (feeling alone or disconnected).
2. Those experiencing higher rates of kinlessness include women, Black adults, people with disabilities, and those having lower wealth. Adults >60 years old experience kinlessness at a rate of 1-11% across the globe.
3. There is limited research about kinlessness in patients experiencing HF, but both social isolation and loneliness have been found to be intertwined with kinlessness. These two constructs poorly impact older adults and have been independently associated with developing cardiovascular disease, stroke, and HF.
4. Kinless patients with HF will likely experience difficulties including physical symptom management, lack of emotional support, financial hardship, increased hospitalization rates, inflation of negative social determinants of health, complex end-of-life care, and subsequently suboptimal to poor HF management.
5. Equitable care for this population would include significant modifications of current advanced HF center requirements for treatment, specifically, modifying social support requirements to qualify for left ventricular assist devices (LVADs) and transplants by using alternative social structures with nontraditional kin.
6. Novel support systems for patients undergoing advanced HF treatments could include new housing models such as shared housing, co-housing, villages, or university-based retirement communities, to provide them with social support opportunities.
7. Technology integration can benefit these patients by using telehealth, smartphone apps, and community-based LVAD charging stations and support stores to provide support for advanced HF treatments.
8. Updates to guidelines and policies to include modified psychosocial qualifications and the expansion of current family leave and caregiver benefits to include nontraditional caregivers may allow expansion of access to therapy.
9. Increasing LVAD and transplant-trained community health worker programs may benefit this population and reduce inequities of care.
10. Creative and novel solutions are needed to allow equal access to advanced HF treatment despite HF patients experiencing kinlessness.

Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Cardiac Surgery and Heart Failure, Mechanical Circulatory Support, Acute Heart Failure, Cardiovascular Care Team

Keywords: Advanced Heart Failure, Geriatrics, Heart-Assist Devices, Social Support

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