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]
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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 µm (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 µg/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 µg/m3 and only started to rise when PM2.5≥4 µg/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 µg/m3 is far below the daily Australian national standard of 25 µg/m3. Our data suggest that beta-blockers might play a role in preventing adverse association between air pollution and patients with HF.
|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)|
|Web of Science® Times Cited:||12|
|Deposited By:||Menzies Institute for Medical Research|
|Downloads:||60 View Download Statistics|
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