Air pollution worsens the consequences of heart failure

reference

WARD-CAVINESS CK, Danesh Yazdi M, Moyer J, et al. Long-term exposure to air pollution from particles is associated with 30-day re-instructions and hospital visits in patients with heart failure. j am Heart Assoc . 2021; 10 (10): E019430.

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The researchers carried out an observation study using quasi-poisson regression models in order to connect the annual average of the fine dust particles at the time of diagnosis of heart failure (HI) with the number of hospital visits and 30-day re-recordings.

study population

The population data analyzed in this study comes from the research resource of the Environmental Protection Agency (EPA) Clinical and Archived Records Research for Environmental Studies (EPA Cares). This resource consists of electronic patient files that are merged with environmental load data to facilitate environmental health studies. The researchers analyzed data from a total of 20,920 patients with heart failure (10,998 women, 9,922 men). The average age was 68.8 years. There were 13,875 white participants, 5,564 black participants and 1,481 as "other" participants.

pollution

The investigators, who were given primary patient addresses on the street level, estimated the daily fine dust pollution _{2.5 (fine dust with diameters of 2.5 micrometers or smaller) using a validated model. ^{1 Every patient was linked to a 1 × 1 km grid cell, and the researchers used this grid cell to to calculate average annual air pollution pollution. They determined the initial diagnosis of heart failure and hospital admissions by electronic patient files.}}

target parameter

The researchers used quasi-poisson models used according to age, breed, gender, year of heart failure diagnosis, smoking status, socio-economic status in the neighborhood, percentage urbanity, pre-existing chronic diseases and short-term air pollution models to be assigned to the annual average at the time of the time HF diagnosis with the number of hospital visits and 30-day re-occupations.

important knowledge

A total of 442,244 hospital visits were recorded for this patient cohort over an average follow -up period of 2.79 years.

a 1-µg/m 3 An increase in fine dust pollution was associated with an increase of 9.31 % (95 % AI, 7.85 % –10.8 %) of hospital visits; an increase of 4.35 % (95 % AI, 1.12 % –7.68 %) in inpatient recordings; And an increase of 14.2 % (95 % AI, 8.41 % –20.2 %) in the 30-day re-resolutions. These associations were robust compared to various modeling approaches.

The authors conclude: "An increased exposure to air pollution in patients with heart failure increases 30-day resumption, outpatient visits and inpatient shots, which indicates a general increase in morbidity with increasing exposure."

practice implications

In the United States, the prevalence of heart failure increases. By 2030, an estimated 8 million people will have heart failure, an increase of 46 % compared to 2012. In 2012, the total cost of heart failure in the United States was estimated at $ 30.7 billion, with about 68 % of these costs on direct health costs such as hospital visits and inpatient stays. By 2030, the cost of heart failure will be estimated at $ 69.8 billion, which corresponds to an increase of 127 %.

These filters are inexpensive and designed to be replaced at regular intervals, but only a few people are aware of it, they still know that these filters are available as a HEPA filter that were specially developed for removing fine dust.

Although our attention is pointed to every single patient in clinical practice, these larger trends are worth mentioning because they indicate who and what we will see in the examination room.

Thanks to the Affordable Care Act, the hospitals imposed fine for poor performance, the re -admission rates of hospitals are now a key measure in the performance assessment of hospitals. As part of the Hospital Remissions Reduction Program, increased 30-day re-recording rates caused 3 % of the medical and medical and medical fees for performance payments in heart failure and 5 other diseases. Even if 3 % may not sound like a lot, in 2020 they mundled millions of dollars. Even if the financial concerns of companies are not at the top of our concerns, this study provides a valuable calculation for evaluating difficult risks through pollution.

It is generally known that long -term exposure compared to air pollution increases the risk of hospitalization. A study by Danesh Yazdi from 2019 reported on long-term exposure to fine dust 2.5 was associated with an increased probability of inpatient admission in the Medicare population, even in areas where PM 2.5 3 . 3

The biological mechanisms to explain these associations have been well explained and include systemic inflammation, increased activation of the autonomous nervous system and oxidative stress, which is induced by the penetration of PM _{2.5 The current Ward caviness study only considered the sub-group of patients with existing heart failure. In order to summarize the results, a 1-µg/m 3 fine dust pollution was connected by 9.31 %, an increase in inpatient recordings by 4.35 % and an increase in 30-day recovery by 14.2 % (see section "key results" for confidence intervals). In this data, black patients with heart failure had the highest associations between the hospital visits as a whole and the long -term exposure to air pollution; The associated risk was 40 % higher in black patients than in white patients. These racial differences were even greater in 30-day returns. Since minorities are often exposed to above-average air pollution, it is possible that some of the health differences observed in heart failure patients are caused by exposure to air pollution.}

A similar explanation could contribute to the racial differences in breast cancer rates in black women who are more likely to have aggressive subtypes of breast cancer. High PM 2.5 exposure was associated with a higher risk of more aggressive forms of breast cancer.

Data such as those presented in this and other recent studies suggest that certain subgroups of patients-in this case with decompensated heart failure-could benefit from reducing their PM exposure 2.5 . Even if we believe that this is a problem that should be addressed at local, state or national level, our patients who suffer from an illness should not be asked to wait until the political leadership or even basic organizations cause changes. Rather, they should be encouraged to take proactive measures to reduce their own exposure.

Exposition can be reduced by modern ventilation and filter systems in residential and business buildings. Modern cars are equipped with air filters in the interior. These filters are inexpensive and designed to be exchanged at regular intervals, but only a few people are aware of it, they still know that these filters are available as a HEPA filter that were specially developed for removing fine dust.

Health practitioners should use this new data in relation to congestive heart failure and PM 2.5 to specifically encourage patients with cardiovascular diseases to actively reduce their exposure. A clinical study by Maestas et al. (N = 40) from 2018, which was carried out in Detroit, Michigan, reported that portable air filters in the household reducing fine dust 2.5 exposure by more than 50 %.

According to the database of the World Bank, average PM exposure 2.5 , 3 in 2011 fell in the United States to 7.41 µg/m in 2017. ^{10 The EPA offers current information according to postcode on www.airnow.gov . 11 If the results of Maestas are correct and the home filter are reduced by half - let's say, another 3.5 µg/m 3 (3.5 x 9.3 = 32.55 %) - Such intervention could reduce hospital visits for patients with heart failure by a third. For us and our patients, it is not about reducing health costs, but about reducing suffering, and these numbers indicate that the efforts to reduce the stress of air pollutants could consider and are worth it.}