Heart failure patients are more likely to die from their condition on polluted days and up to two days after, according to the study. The research was presented at the European Society of Cardiology (ESC) Heart Failure 2023 scientific conference.
“The findings suggest that reducing air pollution has the potential to prevent the worsening of heart failure,” said study author Dr Lukasz Kuzma of the Medical University of Bialystok in Poland.
“The protection of vulnerable groups, especially in winter, should become an integral part of clinical care. This means health professionals work with patients to monitor air quality and choose optimal times for outdoor activities.”
According to the World Health Organization (WHO), air pollution is the single most serious environmental threat to human health. These include particulate matter (PM) 2.5 and PM10, which are mostly caused by vehicle exhaust emissions and industrial odors. In 2019, air pollution is projected to cause 4.2 million premature deaths worldwide.
Heart failure affects more than 64 million people worldwide.4 The authors of the current study previously found that increases in particulate matter were associated with increased hospitalizations for heart failure.5 This study examined the relationship between smog exposure and short-term heart failure mortality.
Mortality data from the five main cities in eastern Poland from 2016 to 2020 were obtained from the Central Statistical Office. PM2.5 and PM10 concentrations were obtained from the Environmental Protection Inspectorate. Home zip codes were used to link individual pollution exposure to mortality.
The researchers used a time-stratified case crossover study design in which participants served as their own controls. This eliminated the potential confounding effect of individual characteristics. For each participant, pollutant levels on the day the death occurred (eg, Tuesday) were compared with pollutant levels on the same day of the week without death (eg, all other Tuesdays) in the same month.
Analyzes were repeated for pollution levels one day and two days before death. All analyzes were adjusted for factors that may have influenced the relationships, including season, day of the week, weather conditions (temperature, humidity, and atmospheric pressure), and long-term trends such as population demographics.
A total of 87,990 deaths were recorded during the five-year study, including 7,404 from heart failure. The average age of those who died from heart failure was 74, and 49% were women. Most died in winter and least in summer, with an average of 1.03 and 0.69 per day.
A 10 mg/m3 increase in PM2.5 and PM10 was associated with a 10% and 9% increase in the risk of death from heart failure on a polluted day, respectively. A similar risk of death from heart failure was observed one and two days after smog exposure.
Dr Kuzma said: “The results suggest that pollution continues to have negative effects on heart health two days after smog exposure. Heart failure patients should minimize their exposure to polluted areas by avoiding outdoor activities in areas with heavy traffic or high levels of pollution and using air filters at home. In addition, patients can advocate for policies and actions to improve air quality in their communities.”
He concluded: “Our research suggests that considering the impact of pollution on public health measures to prevent disease and the consequences of ill health could lead to positive outcomes for heart failure patients. Such measures should be taken in parallel with clinical care to improve the prognosis of this condition.”
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