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Association of ambient particulate matter with heart failure incidence and all-cause readmissions in Tasmania: an observational study


Huynh, QL and Blizzard, CL and Marwick, TH and Negishi, K, Association of ambient particulate matter with heart failure incidence and all-cause readmissions in Tasmania: an observational study, BMJ Open, 8, (5) Article e021798. ISSN 2044-6055 (2018) [Refereed Article]


Copyright Statement

Article author(s) 2018. All rights reserved. Licensed under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

DOI: doi:10.1136/bmjopen-2018-021798


Objectives: We sought to investigate the relationship between air quality and heart failure (HF) incidence and rehospitalisation to elucidate whether there is a threshold in this relationship and whether this relationship differs for HF incidence and rehospitalisation.

Methods: This retrospective observational study was performed in an Australian state-wide setting, where air pollution is mainly associated with wood-burning for winter heating. Data included all 1246 patients with a first-ever HF hospitalisation and their 3011 subsequent all-cause readmissions during 2009-2012. Daily particulate matter <2.5 m (PM2.5), temperature, relative humidity and influenza infection were recorded. Poisson regression was used, with adjustment for time trend, public and school holiday and day of week.

Results: Tasmania has excellent air quality (median PM2.5=2.9 g/m3 (IQR: 1.8-6.0)). Greater HF incidences and readmissions occurred in winter than in other seasons (p<0.001). PM2.5 was detrimentally associated with HF incidence (risk ratio (RR)=1.29 (1.15-1.42)) and weakly so with readmission (RR=1.07 (1.02-1.17)), with 1 day time lag. In multivariable analyses, PM2.5 significantly predicted HF incidence (RR=1.12 (1.01-1.24)) but not readmission (RR=0.96 (0.89-1.04)). HF incidence was similarly low when PM <4 g/m3 and only started to rise when PM2.5≥4 g/m3. Stratified analyses showed that PM2.5 was associated with readmissions among patients not taking beta-blockers but not among those taking beta-blockers (pinteraction=0.011).

Conclusions: PM2.5 predicted HF incidence, independent of other environmental factors. A possible threshold of PM2.5=4 g/m3 is far below the daily Australian national standard of 25 g/m3. Our data suggest that beta-blockers might play a role in preventing adverse association between air pollution and patients with HF.

Item Details

Item Type:Refereed Article
Keywords:air pollution, environment, heart failure, threshold, time series, wood smoke
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Environmental Management
Objective Group:Air quality, atmosphere and weather
Objective Field:Atmospheric processes and dynamics
UTAS Author:Huynh, QL (Dr Quan Huynh)
UTAS Author:Blizzard, CL (Professor Leigh Blizzard)
UTAS Author:Marwick, TH (Professor Tom Marwick)
UTAS Author:Negishi, K (Dr Kazuaki Negishi)
ID Code:126365
Year Published:2018
Web of Science® Times Cited:16
Deposited By:Menzies Institute for Medical Research
Deposited On:2018-06-06
Last Modified:2022-08-30
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