Abstract 2939: Heart Failure Exacerbation and Exposure to Fine Particulate Air Pollution
Cardiopulmonary disease and mortality have been associated with exposure to elevated concentrations of ambient particulate matter air pollution (PM). There is evidence that exposure to elevated concentrations of PM increases the risk of acute ischemic heart disease events, alters cardiac autonomic function, and increases the risk of arrhythmias. It is plausible, therefore, that PM exposure may also exacerbate heart failure (HF) by triggering acute cardiac decompensation through PM’s effects on myocardial ischemia, cardiac autonomic function, and/or arrhythmic effects. This study directly explores the potential association between exacerbated HF following exposure to elevated PM exposure. A case-crossover study design was used to explore associations between ambient fine particulate air pollution (PM2.5, particles with an aerodynamic diameter ≤ 2.5 μm, measured at 10-μg/m3) and 2,628 HF hospitalizations. Study patients lived on the Wasatch Front in Utah and were drawn from all those hospitalized at Intermountain Healthcare Hospitals with a primary discharge diagnosis of HF. A 14-day lagged cumulative moving average of PM2.5 was associated with a 13.1% (95% CI: 1.3% – 26.2%) increase in HF admissions (p=0.028). The strongest PM2.5-HF associations were for elderly patients who had previously been admitted to the hospital for HF and who required only a short period of hospitalization. For patients hospitalized previously for HF (n=999), 14-day lagged cumulative moving average of PM2.5 exposure was associated with a 32.4% (95% CI: 10.7, 58.4) increase in HF readmission (p=0.002). The 21-day lagged moving average of PM2.5 exposure was also associated with increased risk (14.5%, p=0.036), while concurrent day (0.8%, p=0.77) and 1-day lag (1.5%, p=0.59) had similar effect size as prior studies that did not utilize moving averages. Heart failure exacerbations, as represented by hospitalization, are significantly associated with lagged cumulative exposure to PM2.5 of approximately two weeks. These results suggest that air pollution may play a small but important role in precipitating acute cardiac decompensation in otherwise well-managed HF patients.