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BMJ Open. 2018 May 10;8(5):e021798. doi: 10.1136/bmjopen-2018-021798.
Association of ambient particulate matter with heart failure incidence and all-cause readmissions in Tasmania: an observational study.
Huynh QL1, Blizzard CL1, Marwick TH1,2, Negishi K1.
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Abstract
OBJECTIVES:
We sought to investigate the relationship between air quality and heart failure (HF) incidence and rehospitalisation to elucidate whether there is a threshold in this relationship and whether this relationship differs for HF incidence and rehospitalisation.
METHODS:
This retrospective observational study was performed in an Australian state-wide setting, where air pollution is mainly associated with wood-burning for winter heating. Data included all 1246 patients with a first-ever HF hospitalisation and their 3011 subsequent all-cause readmissions during 2009-2012. Daily particulate matter <2.5 ?m (PM2.5), temperature, relative humidity and influenza infection were recorded. Poisson regression was used, with adjustment for time trend, public and school holiday and day of week.
RESULTS:
Tasmania has excellent air quality (median PM2.5=2.9 ?g/m3 (IQR: 1.8-6.0)). Greater HF incidences and readmissions occurred in winter than in other seasons (p<0.001). PM2.5 was detrimentally associated with HF incidence (risk ratio (RR)=1.29 (1.15-1.42)) and weakly so with readmission (RR=1.07 (1.02-1.17)), with 1 day time lag. In multivariable analyses, PM2.5 significantly predicted HF incidence (RR=1.12 (1.01-1.24)) but not readmission (RR=0.96 (0.89-1.04)). HF incidence was similarly low when PM <4 ?g/m3 and only started to rise when PM2.5≥4 ?g/m3. Stratified analyses showed that PM2.5 was associated with readmissions among patients not taking beta-blockers but not among those taking beta-blockers (pinteraction=0.011).
CONCLUSIONS:
PM2.5 predicted HF incidence, independent of other environmental factors. A possible threshold of PM2.5=4 ?g/m3 is far below the daily Australian national standard of 25 ?g/m3. Our data suggest that beta-blockers might play a role in preventing adverse association between air pollution and patients with HF.
? Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
KEYWORDS:
air pollution; environment; heart failure; threshold; time series; wood smoke
PMID: 29748348 DOI: 10.1136/bmjopen-2018-021798
Free full text
Association of ambient particulate matter with heart failure incidence and all-cause readmissions in Tasmania: an observational study.
Huynh QL1, Blizzard CL1, Marwick TH1,2, Negishi K1.
Author information
Abstract
OBJECTIVES:
We sought to investigate the relationship between air quality and heart failure (HF) incidence and rehospitalisation to elucidate whether there is a threshold in this relationship and whether this relationship differs for HF incidence and rehospitalisation.
METHODS:
This retrospective observational study was performed in an Australian state-wide setting, where air pollution is mainly associated with wood-burning for winter heating. Data included all 1246 patients with a first-ever HF hospitalisation and their 3011 subsequent all-cause readmissions during 2009-2012. Daily particulate matter <2.5 ?m (PM2.5), temperature, relative humidity and influenza infection were recorded. Poisson regression was used, with adjustment for time trend, public and school holiday and day of week.
RESULTS:
Tasmania has excellent air quality (median PM2.5=2.9 ?g/m3 (IQR: 1.8-6.0)). Greater HF incidences and readmissions occurred in winter than in other seasons (p<0.001). PM2.5 was detrimentally associated with HF incidence (risk ratio (RR)=1.29 (1.15-1.42)) and weakly so with readmission (RR=1.07 (1.02-1.17)), with 1 day time lag. In multivariable analyses, PM2.5 significantly predicted HF incidence (RR=1.12 (1.01-1.24)) but not readmission (RR=0.96 (0.89-1.04)). HF incidence was similarly low when PM <4 ?g/m3 and only started to rise when PM2.5≥4 ?g/m3. Stratified analyses showed that PM2.5 was associated with readmissions among patients not taking beta-blockers but not among those taking beta-blockers (pinteraction=0.011).
CONCLUSIONS:
PM2.5 predicted HF incidence, independent of other environmental factors. A possible threshold of PM2.5=4 ?g/m3 is far below the daily Australian national standard of 25 ?g/m3. Our data suggest that beta-blockers might play a role in preventing adverse association between air pollution and patients with HF.
? Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
KEYWORDS:
air pollution; environment; heart failure; threshold; time series; wood smoke
PMID: 29748348 DOI: 10.1136/bmjopen-2018-021798
Free full text