The Impact of Environmental Factors on the Mortality of Patients With Chronic Heart Failure

• Published in: The American journal of cardiology Vol. 146; pp. 48 - 55
• Main Authors: Lopez, Persio D., Cativo-Calderon, Eder H., Otero, Diana, Rashid, Mahjabeen, Atlas, Steven, Rosendorff, Clive
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2021; Elsevier Limited
• Subjects: Acute coronary syndromes; Aged; Aged, 80 and over; Air pollution; Air quality; Climate; Congestive heart failure; Environmental effects; Environmental Exposure - adverse effects; Environmental factors; Environmental impact; Environmental protection; Etiology; Female; Gender; Geographical distribution; Geographical locations; Geography; Heart failure; Heart Failure - mortality; Humans; Hypertension; Influenza; Male; Mortality; Multivariate analysis; Nitrogen dioxide; Outdoor air quality; Particulate Matter - adverse effects; Pneumonia; Pollutants; Population studies; Precipitation; Regression analysis; Retrospective Studies; Risk Assessment - methods; Risk Factors; Seasonal variations; Seasons; Snow; Summer; Survival Rate - trends; Temperature; United States - epidemiology; Urban areas; Urban environments; Weather; Winter; United States; United States > US; Alaska
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2021.01.019

•The mortality rate of patients with chronic heart failure peaks during wintertime.•Air temperature and nitrogen dioxide concentrations are associated with this trend.•This pattern is consistent throughout latitudes, but associated factors vary by location.•In large cities, worsening air quality indexes are associated with higher mortality. Outcomes of acute heart failure hospitalizations are worse during the winter than the rest of the year. Seasonality data are more limited for outcomes in chronic heart failure and the effect of environmental variables is unknown. In this population-level study, we merged 20-year data for 555,324 patients with heart failure from the national Veterans Administration database with data on climate from the National Oceanic and Atmospheric Administration and air pollutants by the Environmental Protection Agency. The outcome was the all-cause mortality rate, stratified by geographical location and each month. The impact of environmental factors was assessed through Pearson's correlation and multiple regression with a family-wise α = 0.05. The monthly all-cause mortality was 13.9% higher in the winter than the summer, regardless of gender, age group, and heart failure etiology. Winter season, lower temperatures, and higher concentrations of nitrogen dioxide were associated with a higher mortality rate in multivariate analysis of the overall population. Different environmental factors were associated in regions with similar patterns of temperature and precipitation. The only environmental factor associated with the mortality rate of patients dwelling in large urban centers was the air quality index. In conclusion, the mortality in chronic heart failure exhibits a seasonal pattern, regardless of latitude or climate. In this group of patients, particularly those of male gender, a higher mortality was associated with environmental factors and incorporating these factors in treatment plans and recommendations could have a favorable cost-benefit ratio.