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


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Huynh, QL ORCID: 0000-0003-1368-5160, Blizzard, CL ORCID: 0000-0002-9541-6943, Marwick, TH ORCID: 0000-0001-9065-0899 and Negishi, K ORCID: 0000-0002-9086-2565 2018 , 'Association of ambient particulate matter with heart failure incidence and all-cause readmissions in Tasmania: an observational study' , BMJ Open, vol. 8, no. 5 , pp. 1-8 , doi: 10.1136/bmjopen-2018-021798.

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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), 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 (p2.5 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 3 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: Article
Authors/Creators:Huynh, QL and Blizzard, CL and Marwick, TH and Negishi, K
Keywords: air pollution, environment, heart failure, threshold, time series, wood smoke
Journal or Publication Title: BMJ Open
Publisher: BMJ Group
ISSN: 2044-6055
DOI / ID Number: 10.1136/bmjopen-2018-021798
Copyright Information:

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

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