According to a study presented at Heart Failure 2023, a scientific congress of the European Society of Cardiology (ESC), heart failure patients are at a higher risk of dying from their condition on polluted days and for up to two days following exposure.
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The findings indicate that reducing air pollution has the potential to prevent worsening heart failure. Protecting vulnerable groups, especially during winter, should become an integral part of clinical care. That means health professionals working with patients to monitor air quality and choose optimal times for outdoor activity.
Dr. Lukasz Kuzma, Study Author, Medical University of Bialystok
According to the World Health Organization (WHO), air pollution is the single most serious environmental danger to human health. This includes particulate matter (PM)2.5 and PM10, caused mainly by vehicle exhaust emissions and industrial fumes. In 2019, it was predicted that ambient air pollution caused 4.2 million premature deaths worldwide.
More than 64 million people worldwide suffer from heart failure. The present study’s authors previously discovered that increases in particulate matter were connected with an increase in heart failure hospitalizations. This study looked at the link between smog exposure and short-term heart failure mortality.
The Central Statistical Office provided mortality data from the five major cities in Eastern Poland from 2016 to 2020. The Inspectorate for Environmental Protection provided PM2.5 and PM10 concentrations. Individual pollution exposure was linked to mortality using home postcodes.
The researchers utilized a time-stratified case-crossover study design, with participants acting as their controls. This avoided the possibility of individual characteristics distorting the results. Pollutant levels on the day of the week when a death occurred (e.g., Tuesday) were compared for each participant to pollutant levels on the same day of the week when no deaths happened (e.g., all subsequent Tuesdays) in the same month.
The analyses were repeated one and two days before a death to look at pollution levels. All studies were adjusted for parameters such as time of year, day of the week, weather conditions (temperature, humidity, and atmospheric pressure), and long-term patterns such as population demographics.
During the five-year study, 87,990 deaths were observed, with heart failure accounting for 7,404. The average age of individuals who died from heart failure was 74 years old, with women accounting for 49% of those who died.
Winter had the highest number of deaths, while summer had the lowest, with averages of 1.03 and 0.69 per day, respectively. A 10 µg/m3 increase in PM2.5 and PM10 was related to a 10% and 9% increase in the probability of death due to heart failure on a polluted day, respectively. One and two days after smog exposure, similar chances of dying from heart failure were reported.
The results suggest that pollution continues to exert negative effects on heart health for two days after smog exposure. Patients with heart failure should minimize their time in polluted areas, for example by avoiding outdoor activities in places with dense traffic or when pollution levels are high, and using air filters at home. In addition, patients can advocate for policies and actions to improve air quality in their communities.
Dr. Lukasz Kuzma, Study Author, Medical University of Bialystok
“Our research indicates that considering the impact of pollution in public health measures to prevent disease and the consequences of ill health could lead to positive outcomes for patients with heart failure. Such measures should be taken in parallel with clinical care to improve the prognosis of this condition,” Dr. Kuzma concluded.
The project is supported by the National Science Centre in Poland grant UMO-2021/41/B/NZ7/03716 and by research grants from the Medical University of Bialystok UMB- B.SUB.23.290 and UMB-B.SUB.23.509.