Association between Air Pollution and Emergency Room Visits for Atrial Fibrillation

Exploring the Relationship between Acute Coronary Syndrome, Lower Respiratory Tract Infections, and Atmospheric Pollution

Background: Respiratory infections were found to be connected with the incidence of acute coronary syndrome (ACS). The proposed pathway of this connection includes inflammation, oxidative stress, pro-coagulation, and atherosclerotic plaque destabilization. This can cause rapture and thrombus formation, leading to ACS. Our study aimed to assess the risk factors for coronary artery thrombosis as a manifestation of ACS and for lower respiratory tract infections (LRTIs) in patients with ACS. Methods: The study included 876 patients with ACS from January 2014 to December 2018. Both the clinical data and air pollution data were analyzed. Statistical tests used for analysis included Student's t-test, the Mann-Whitney U-test, the Chi-squared test, and the odds ratio Altman calculation. Results: LRTIs were found in 9.13% patients with ACS. The patients with LRTI had a higher risk of coronary artery thrombosis (OR: 2.4903; CI: 1.3483 to 4.5996). Moreover, they had increased values of inflammatory markers, were older, had a lower BMI, and a higher rate of atrial fibrillation. The average atmospheric aerosols with a maximum diameter of 2.5 μm (PM2.5 concentration) from three consecutive days before hospitalization for ACS were higher in patients with LRTI. Conclusions: The occurrence of coronary artery thrombosis was higher among the patients with LRTI during ACS. PM2.5 exposition was higher in the three consecutive days before hospitalization in patients with LRTI during ACS.

Oil and gas development exposure and atrial fibrillation exacerbation: a retrospective study of atrial fibrillation exacerbation using Colorado's all payer claims dataset

Introduction

Emerging risk factors for atrial fibrillation (AF) incidence and episodes (exacerbation), the most common and clinically significant cardiac arrhythmia, include air and noise pollution, both of which are emitted during oil and natural gas (O&G) well site development.

Methods

We evaluated AF exacerbation risk and proximity to O&G well site development by employing a novel data source and interrupted time-series design. We retrospectively followed 1,197 AF patients living within 1-mile of an O&G well site (at-risk of exposure) and 9,764 patients living >2 miles from any O&G well site (unexposed) for AF claims in Colorado's All Payer Claims Dataset before, during, and after O&G well site development. We calculated AF exacerbation risk with multi-failure survival analysis.

Results

The analysis of the total study population does not provide strong evidence of an association between AF exacerbation and proximity to O&G wells sites during (HR = 1.07, 95% CI: 0.94, 1.22) or after (HR = 1.01, 95% CI: 0.88, 1.16) development. However, AF exacerbation risk differed by patient age and sex. In patients >80 years living within 0.39 miles (2,059 feet) of O&G well site development, AF exacerbation risk increased by 83% (HR = 1.83, 95% CI: 1.25, 2.66) and emergency room visits for an AF event doubled (HR = 2.55, 95% CI: 1.50, 4.36) during development, with risk increasing with proximity. In female patients living within 0.39 miles of O&G well site development, AF exacerbation risk increased by 56% percent (95% CI: 1.13, 2.15) during development. AF exacerbation risk did not persist past the well development period. We did not observe increased AF exacerbation risk in younger or male patients.

Discussion

The prospect that proximity to O&G well site development, a significant noise and air pollution source, may increase AF exacerbation risk in older and female AF patients requires attention. These findings support appropriate patient education to help mitigate risk and development of mitigation strategies and regulations to protect the health of populations in O&G development regions.

Associations of Dietary and Lifestyle Components with Atrial Fibrillation

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia that still remains a significant health concern, especially due to its consequences, including stroke and heart failure. This review explores the intricate interplay between AF, lifestyle choices, and dietary habits. It is particularly focused on findings from diverse studies about non-pharmacological methods of managing AF. Moreover, its purpose is to elucidate the implementation of lifestyle changes such as physical activity or proper diet choices in the integrated treatment strategy of patients with AF.

Short animated video increases knowledge and perceived comfort in clinical counseling on inequitable health impacts of air pollution among interprofessional health learners and clinicians

BACKGROUND

Air pollution is a major health risk contributing to global morbidity and mortality, yet clinicians do not routinely engage in counseling patients on this topic. Clinicians cite their lack of education as a common barrier. We developed a two-minute animated video on mitigating air pollution health risks and evaluated the efficacy of this video as an educational tool.

METHODS

In March-June 2021, a convenience sample of Minnesota interprofessional health learners and clinicians viewed the video and completed an electronic survey that assessed pre-/post-video intervention changes in (a) didactic and clinically applied knowledge on health impacts of air pollution, (b) perceived comfort in identifying at-risk patients and counseling them on relevant preventive health behaviors, (c) intentions/barriers to counseling patients, (d) beliefs and attitudes related to the health harms of air pollution, and (e) perceptions of the overall acceptability of the intervention.

RESULTS

The 218 participants included learners and clinicians in medicine, nursing, and advanced practice provision. Respondents' knowledge scores and self-reported level of comfort in identifying high-risk patients and counseling them on preventative health behaviors increased significantly pre-/post-intervention. The video also effectively altered participants' misperceptions about the health impacts of air pollution. While less than half of participants (43.6%) reported they intended to engage in counseling patients as a result of watching the video, 52.3% indicated they might do so. Lack of time during clinical encounters and lack of training were reported as persistent barriers to engaging in this counseling. Overall, participants found the video to be an effective educational tool, indicating that they wanted their colleagues and patients to watch the video and would like to see further short, animated videos on other environmental health topics.

CONCLUSIONS

A two-minute animated educational video significantly improved knowledge of inequitable health impacts of air pollution and improved perceived comfort in identifying and counseling at-risk patients among health professional learners and clinicians regardless of profession, level of training, or pre-intervention knowledge level. Academic health professional training programs and health systems should consider adopting this modality as a tool for educating learners, clinicians, and patients on environmental health risks.

Air Pollution and Arrhythmias

Air pollution is commonly defined as the contamination of the air we breathe by any chemical, physical, or biological agent that is potentially threatening to human and ecosystem health. The common pollutants known to be disease-causing are particulate matter, ground-level ozone, sulphur dioxide, nitrogen dioxide, and carbon monoxide. Although the association between increasing concentrations of these pollutants and cardiovascular disease is now accepted, the association of air pollution and arrhythmias is less well established. In this review we provide an in-depth discussion of the association of acute and chronic air pollution exposure and arrhythmia incidence, morbidity, and mortality, and the purported pathophysiological mechanisms. Increases in concentrations of air pollutants have multiple proarrhythmic mechanisms including systemic inflammation (via increases in reactive oxygen species, tumour necrosis factor, and direct effects from translocated particulate matter), structural remodelling (via an increased risk of atherosclerosis and myocardial infarction or by affecting the cell-to-cell coupling and gap junction function), and mitochondrial and autonomic dysfunction. Furthermore, we describe the associations of air pollution and arrhythmias. There is a strong correlation of acute and chronic air pollutant exposure and the incidence of atrial fibrillation. Acute increases in air pollution increase the risk of emergency room visits and hospital admissions for atrial fibrillation and the risk of stroke and mortality in patients with atrial fibrillation. Similarly, there is a strong correlation of increases of air pollutants and the risk of ventricular arrhythmias, out-of-hospital cardiac arrest, and sudden cardiac death.

Impact of particulate matter on the incidence of atrial fibrillation and the risk of adverse clinical outcomes: A review

BACKGROUND

Atrial fibrillation (AF) is common and increases the risk of stroke and mortality. Previous studies have suggested that air pollution is an important risk factor for new-onset AF. Herein, we review the evidence regarding: 1) the association between exposure to particulate matter (PM) and new-onset AF, and 2) the risk of worse clinical outcomes in patients with pre-existent AF and their relation to PM exposure.

METHODS

A selection of studies between 2000 and 2023 linking PM exposure and AF was performed through searches in PubMed, Scopus, Web of Science, and Google Scholar.

RESULTS

17 studies from different geographical areas demonstrated that exposure to PM was associated with an increased risk of new-onset AF, although the results were heterogeneous regarding the temporal pattern (short- or long-term) ultimately related to AF. Most of the studies concluded that the risk of new-onset AF increased between 2 %-18 % per 10 μg/m³ increment in PM_2.5 or PM₁₀ concentrations, whereas the incidence (percentage of change of incidence) increased between 0.29 %-2.95 % per 10 μg/m³ increment in PM_2.5 or PM₁₀. Evidence about the association between PM and adverse events in patients with pre-existent AF was scarce but 4 studies showed a higher risk of mortality and stroke (between 8 %-64 % in terms of hazard ratio) in patients with pre-existent AF when PM exposure was higher.

CONCLUSIONS

Exposure to PM (both PM_2.5 and PM₁₀) is a risk factor for AF, and a risk factor for mortality and stroke in patients who already suffer from AF. Since the relationship between PM and AF is independent of the region of the world, PM should be considered as a global risk factor for both AF and worse clinical outcomes in AF patients. Specific measures to prevent air pollution exposure need to be adopted.

The association between air pollution and the daily hospital visits for atrial fibrillation recorded by ECG: a cross-sectional study

BACKGROUND

The relationship between air pollution and atrial fibrillation (AF) recorded by electrocardiograph (ECG) has not yet been illustrated which worsens AF precaution and treatment. This research evaluated the association between air pollution and daily hospital visits for AF with ECG records.

METHODS

The study enrolled 4933 male and 5392 female patients whose ECG reports indicated AF from 2015 to 2018 in our hospital. Such data were then matched with meteorological data, including air pollutant concentrations, collected by local weather stations. A case-crossover study was performed to assess the relationship between air pollutants and daily hospital visits for AF recorded by ECG and to investigate its lag effect.

RESULTS

Our analysis revealed statistically significant associations between AF occurrence and demographic data, including age and gender. This effect was stronger in female (k = 0.02635, p < 0.01) and in patients over 65 y (k = 0.04732, p < 0.01). We also observed a hysteretic effect that when exposed to higher nitrogen dioxide(NO2), counting AF cases recorded by ECG may elevate at lag 0 with a maximum odds ratio(OR) of 1.038 (95% CI 1.014-1.063), on the contrary, O3 reduced the risk of daily visits for AF and its maximum OR was at lag 2, and the OR value was 0.9869 (95% CI 0.9791-0.9948). Other air pollutants such as PM2.5, PM10, and SO2 showed no clear relationship with the recorded AF.

CONCLUSION

The associations between air pollution and AF recorded with ECG were preliminarily discovered. Short-term exposure to NO2 was significantly associated with daily hospital visits for AF management.

Correlation of Air Pollution and Prevalence of Acute Pulmonary Embolism in Northern Thailand

BACKGROUND

The relationship between the level of air pollution and acute pulmonary embolism (APE) has had inconsistent results.

OBJECTIVE

This study aimed to analyze the relationship between the high level of air pollution exposure and APE.

METHODS

A ten-year retrospective cohort, single-center study was performed on patients diagnosed with APE from October 2010 to December 2020. The association between air pollution and monthly APE case diagnosis was analyzed.

RESULTS

A total number of 696 patients was included. The effect of every 10 µg/m³ increment of particulate matters with an aerodynamic diameter < 10 µm (PM₁₀) on total monthly APE cases (unprovoked PE and provoked PE) was increased significantly at lag 4, 5 and 6 months with adjusted RR (95% CI) of 1.06 (1.01, 1.12), p = 0.011, 1.07 (1.01, 1.13), p = 0.021 and 1.06 (1.01, 1.12), p = 0.030, respectively. Adjusted RR for APE was significantly increased for PM₁₀ in the second tertile ((adjusted RR (95% CI) 1.76 (1.12, 2.77)), p = 0.014.

CONCLUSIONS

We conclude that PM₁₀ is associated with an increased prevalence of APE cases. The policy for tighter control of air pollution in our country is needed to reduce the impact of air pollutants on people's health.

More obvious association between short-term ambient nitrogen dioxide and atrial fibrillation outpatient visits in cool seasons: A hospital-based study in northwestern China

Atrial fibrillation (AF) is the most common sustained heart rhythm disorder associated with high mortality and morbidity. Limited studies have been conducted to assess the relationship between short-term exposure to ambient air pollution and AF attacks. This study aimed to explore the association between short-term ambient nitrogen dioxide (NO₂) exposure and outpatient visits for AF in Xi'an, China. Data on daily AF outpatient visits and air pollutants from 2013 to 2019 (2555 days) were obtained. A time-series approach using over-dispersed Poisson generalized additive model (GAM) was employed, and stratified analyses were performed to investigate the potential modifying effects by season, age, and gender. A total of 8307 outpatient visits for AF were recorded. Increased levels of NO₂ were associated with increased AF outpatient visits, and the most significant effect estimates were observed at lag 03: A 10 μg/m³ increase of NO₂ at lag 03 was related to an elevation of 5.59% (95% CI: 2.67%, 8.51%) in daily outpatient visits for AF. Stratified analyses showed that there were no gender and age difference in the effect of NO₂, while more obvious association was observed in cool seasons (October to March) than in warm seasons (April to September). In summary, short-term ambient NO₂ exposure can be positively associated with daily outpatient visits for AF, especially in cool seasons. This work provided novel data that the association between air pollutants and AF can vary by seasons, further supporting that the prevention of cardiovascular health effects should be strengthened in winter.

Short-term ambient air pollution exposure and risk of atrial fibrillation in patients with intracardiac devices

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with substantial morbidity and mortality. Short-term exposure to fine particulate matter (PM2.5) has been causally linked to higher risk of cardiovascular disease, but the association with atrial fibrillation (AF) is less clear.

Methods

We conducted a time-stratified case-crossover study to estimate the association between short-term air pollution levels and risk of AF episodes. The episodes were identified among patients with paroxysmal AF and an intracardiac devices able to register and store AF episodes. We obtained air pollution and temperature data from fixed monitoring stations and used conditional logistic regression to quantify the association of PM2.5, particulate matter (PM10), nitrogen dioxide (NO2) and ozone (O3) with onset of AF episodes, adjusting for temperature and public holidays.".

Results

We analyzed 584 episodes of AF from 91 participants and observed increased risk of AF episodes with PM2.5 levels for the 48-72 hours lag (OR 1.05; CI [1.01,1.09] per IQR)] and 72-96 hours (OR 1.05 CI [1.00,1.10] per IQR). Our results were suggestive of an association between O3 levels and AF episodes during the warm season. We did not observe any statistically significant associations for PM10 nor NO2.

Conclusion

Short-term increases in PM2.5 in a low-pollution level environment were associated with increased risk of AF episodes in a population with intracardiac devices. Our findings add to the evidence of a potential triggering of AF by short-term increases in air pollution levels, well below the new WHO air quality guidelines.

Ambient gaseous pollutants and emergency ambulance calls for all-cause and cause-specific diseases in China: a multicity time-series study

Much attention has been paid to the health effects of ambient particulate matter pollution; the effects of gaseous air pollutants have not been well studied. Emergency ambulance calls (EACs) may provide a better indicator of the acute health effects than the widely used health indicators, such as mortality and hospital admission. We estimated the short-term associations between gaseous air pollutants [nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and ozone (O₃)] and EACs for all-cause, cardiovascular, and respiratory diseases in seven Chinese cities from 2014 to 2019. We used generalized additive models and random-effects meta-analysis to examine the city-specific and pooled associations. Stratified analyses were conducted by age, sex, and season. A total of 1,626,017 EACs were observed for all-cause EACs, including 230,537 from cardiovascular diseases, and 96,483 from respiratory diseases. Statistically significant associations were observed between NO₂ and EACs for all-cause diseases, while the effects of SO₂ were positive, but not statistically significant in most models. No significant relationship was found between O₃ and EACs. Specifically, each 10 μg/m³ increase in the 2-day moving average concentration of NO₂ was associated with a 1.07% [95% confidence interval (CI): 0.40%, 1.76%], 0.76% (95% CI: 0.19%, 1.34%) and 0.06% (95% CI: -1.57%, 1.73%) increase in EACs due to all-cause, cardiovascular and respiratory diseases, respectively. Stratified analysis showed a larger effect of NO₂ on all-cause EACs in the cold season [excess relative risk (ERR): 0.33% (95% CI: 0.05%, 0.60%) for warm season, ERR: 0.77% (95% CI: 0.31%, 1.23%) for cold season]. Our study indicates that acute exposures to NO₂ might be an important trigger of the emergent occurrence of all-cause, cardiovascular and respiratory diseases, and this effect should be of particular concern in the cold season. Further policy development for controlling gaseous air pollution is warranted to reduce the emergent occurrence of cardiopulmonary diseases.

The Effect of Outdoor Aeroallergens on Asthma Hospitalizations in Children in North-Western Tuscany, Italy

Few data are currently available on the effects of aeroallergens in triggering respiratory symptoms in children. To evaluate the potential effects of daily outdoor aeroallergens loads on childhood admissions, in this case-crossover study, we analyzed data from 85 children hospitalized at the University Hospital of Pisa, Italy, for asthma or asthma-like symptoms without respiratory infection, between 2010 and 2019. Data were linked to outdoor allergens, temperature, nitrogen dioxide, and relative humidity observed during the same period. A 10-grains/m³ increase in the total aeroallergen concentration was associated with an increased risk of admission at lag 0 (OR = 1.054, 95% CI: 1.011–1.098), with a smaller effect at lag 1 (OR = 1.037, 95% CI: 1.008–1.067) and lag 2 (OR = 1.021, 95% CI: 1.003–1.039). Trends to larger effects were observed in children with sensitization to one or more aeroallergens (OR = 1.085, 95% CI: 1.004–1.173 at lag 0), in males (OR = 1.069, 95% CI: 1.009–1.132 at lag 0) and in older children (OR = 1.065, 95% CI: 1.007–1.127 at lag 0). Our study shows an association between increased outdoor allergens loads and asthma or asthma-like symptoms in children up to at least two days prior to hospitalization, suggesting that tracking aeroallergen counts may be useful to improve the management of respiratory allergic diseases.

Ambient nitrogen dioxide is associated with emergency hospital visits for atrial fibrillation: a population-based case-crossover study in Reykjavik, Iceland

BACKGROUND

In Iceland air quality is generally good; however, previous studies indicate that there is an association between air pollution in Reykjavik and adverse health effects as measured by dispensing of medications, mortality, and increase in health care utilisation. The aim was to study the association between traffic-related ambient air pollution in the Reykjavik capital area and emergency hospital visits for heart diseases and particularly atrial fibrillation and flutter (AF).

METHODS

A multivariate time-stratified case-crossover design was used to study the association. Cases were those patients aged 18 years or older living in the Reykjavik capital area during the study period, 2006-2017, who made emergency visits to Landspitali University Hospital for heart diseases. In this population-based study, the primary discharge diagnoses were registered according to International Classification of Diseases, 10th edition (ICD-10). The pollutants studied were NO₂, PM₁₀, PM_2.5, and SO_2, with adjustment for H₂S, temperature, and relative humidity. The 24-h mean of pollutants was used with lag 0 to lag 4.

RESULTS

During the study period 9536 cases of AF were identified. The 24-h mean NO₂ was 20.7 μg/m³. Each 10 μg/m³ increase in NO₂ was associated with increased risk of heart diseases (ICD-10: I20-I25, I44-I50), odds ratio (OR) 1.023 (95% CI 1.012-1.034) at lag 0. Each 10 μg/m³ increase in NO₂ was associated with an increased risk of AF (ICD-10: I48) on the same day, OR 1.030 (95% CI: 1.011-1.049). Females were at higher risk for AF, OR 1.051 (95% CI 1.019-1.083) at lag 0, and OR 1.050 (95% CI 1.019-1.083) at lag 1. Females aged younger than 71 years had even higher risk for AF, OR 1.077 (95% CI: 1.025-1.131) at lag 0. Significant associations were found for other pollutants and emergency hospital visits, but they were weaker and did not show a discernable pattern.

CONCLUSIONS

Short-term increase in NO₂ concentrations was associated with heart diseases, more precisely with AF. The associations were stronger among females, and among females at younger age. This is the first study in Iceland that finds an association between air pollution and cardiac arrhythmias, so the results should be interpreted with caution.

Air Pollution and Cardiac Arrhythmias: From Epidemiological and Clinical Evidences to Cellular Electrophysiological Mechanisms

Cardiovascular disease is the leading cause of death worldwide and kills over 17 million people per year. In the recent decade, growing epidemiological evidence links air pollution and cardiac arrhythmias, suggesting a detrimental influence of air pollution on cardiac electrophysiological functionality. However, the proarrhythmic mechanisms underlying the air pollution-induced cardiac arrhythmias are not fully understood. The purpose of this work is to provide recent advances in air pollution-induced arrhythmias with a comprehensive review of the literature on the common air pollutants and arrhythmias. Six common air pollutants of widespread concern are discussed, namely particulate matter, carbon monoxide, hydrogen sulfide, sulfur dioxide, nitrogen dioxide, and ozone. The epidemiological and clinical reports in recent years are reviewed by pollutant type, and the recently identified mechanisms including both the general pathways and the direct influences of air pollutants on the cellular electrophysiology are summarized. Particularly, this review focuses on the impaired ion channel functionality underlying the air pollution-induced arrhythmias. Alterations of ionic currents directly by the air pollutants, as well as the alterations mediated by intracellular signaling or other more general pathways are reviewed in this work. Finally, areas for future research are suggested to address several remaining scientific questions.

Solar and geomagnetic activity enhance the effects of air pollutants on atrial fibrillation

AIMS

Cardiac arrhythmias have been associated with intense solar and geomagnetic activity (SGA) and exposures to air pollution.

METHODS

We examined whether oscillations of SGA can modify the effect of hourly exposures to air pollutants on atrial fibrillation ≥30 s (AF) risk in patients with dual-chamber implantable cardioverter-defibrillators. The effects of SGA on ambient particulate matter <2.5 µm (PM2.5), black carbon (BC), ultrafine particles (PN), and associations with AF were assessed. Measures of SGA included solar wind proton density (SW), total interplanetary magnetic field strength (IMF), and Kp index, a measure of global geomagnetic activity.

RESULTS

Overall time lags between 0 and 24 h, periods of increased SGA (>50th percentile in IMF, SW, and Kp index) enhanced the effects of all three air pollutants on AF, while during periods of reduced SGA the associations were considerably weaker or absent. During periods of intense SW 6 h prior to an AF event, the odds ratio (OR) for PM2.5 exposure per interquartile range (IQR) of 5.6 µg/m3 was 1.7 [95% confident interval (CI) 1.3-2.3, P = 0.0001]. For periods of reduced SW, the OR for PM2.5 exposure per IQR was 1.2 (95% CI 0.9-1.5; P = 0.27). There were similar effects for PN and BC exposures. In patients with multiple AF events per hour, the associations with air pollutants during intense SGA were even greater.

CONCLUSION

The effects of air pollutants up to 24 h before AF events were enhanced during periods of increased SGA. Our results suggest that these effects may account for variation in AF risk.

Short-term exposure to ambient air pollution and atrial fibrillation hospitalization: A time-series study in Yancheng, China

Atrial fibrillation (AF) is an important cardiovascular disease that causes a great burden of disease. However, there is limited evidence of a link between air pollution exposure and AF. This study aimed to explore the short-term association between air pollution and AF. We obtained daily hospitalization of AF in two major hospitals of Yancheng, China from May, 2015 to May, 2020. Generalized additive models with quasi-Poisson regression were used to assess the associations between six criteria air pollutants and AF hospitalization. We explored the lag patterns, and visualized the concentration-response relationships. The robustness of the association was tested by two-pollutant model, and we explored potential effect modification by age, sex and season. A total of 15,171 inpatients from two hospitals were collected in this study with an average daily count of eight patients. We observed consistent and significant associations between six air pollutants and AF on lag 0-4 days. A 10 ug/m3 increase in PM2.5 was associated with 2.81% (95%CI: 1.44%, 4.20%) changes in AF, and the effect estimate was 1.67% (95%CI: 0.77%, 2.59%) for PM10, 4.90% (95%CI: 1.69%, 8.22%) for NO2, 6.81% (95%CI: 0.46%, 13.57%) for SO2, 1.82% (95%CI: 0.60%, 3.06%) for O3; a 0.1 mg/m3 increase in CO was associated with 2.55% (95%CI: 0.91%, 4.21%) increments in AF. Associations of PM2.5 and PM10 were robust after adjusting for SO2, NO2, CO, and O3, but not vice versa. Female patients and those aged less 70 years had larger risk of AF associated with air pollution exposure. The concentration-response curves of the six pollutants were almost linear and increasing with no obvious thresholds. This time-series study in Yancheng demonstrated increased risk of AF and a delayed effect over lag 0-4 days. Our findings suggested need of prevention and protection against these environmental risk factors for AF in health departments.

Impact of ambient fine particulate matter on emergency department admissions for circulatory system disease in a city in Northeast China

The cardiovascular impact of fine particles has caused great concern worldwide. However, evidences on the impact of fine particulate matter (PM_2.5) on emergency department (ED) admissions for circulatory system disease in Northeast China is limited. We assessed the acute, lag, cumulative, and harvesting effects of PM_2.5 on ED admissions for circulatory system diseases and their exposure-response relationship. A total of 26,168 ED admissions, including those for hypertension, ischemic heart disease (IHD), arrhythmia, heart failure (HF), and cerebrovascular events (CVE), were collected from the Shenyang Emergency Center from 1 January 2017 to 31 December 2018. The relationship between PM_2.5 and ED admissions for circulatory system disease was estimated using a distributed lag non-linear model and a generalized additive quasi-Poisson model. We stratified the analyses by temperature. Air pollution was positively correlated with daily ED admissions for circulatory system disease or other cause-specific diseases under different lag structures. For every 10-μg/m³ increase in the PM_2.5 concentration, the relative risk of daily ED admissions for circulatory system disease was 1.007 [95% confidence interval (CI), 1.001-1.013] in lag0, 1.007 (95%CI, 1.000-1.013) in lag1, and 1.011 (95%CI, 1.002-1.021) in lag03. A lag effect was found in IHD, a cumulative effect was found in CVE, and both lag and cumulative effects were found in hypertension and arrhythmia. A harvesting effect was observed in daily ED admissions for circulatory system disease and HF. We found no interaction between pollutants and temperature. We observed a monotonic and almost linear exposure-response relationship between PM_2.5 and circulatory system disease with no threshold effect.PM_2.5 contributes to obvious acute, lag, cumulative, and harvesting effects on circulatory system disease. PM_2.5 was associated with the risk of daily ED admissions for circulatory system disease, hypertension, IHD, arrhythmia, HF, and CVE. Therefore, air quality management must be strengthened.

The association between air pollution parameters and emergency department visits and hospitalizations due to cardiovascular and respiratory diseases: a time-series analysis

OBJECTIVE

In this study, the association between cardiovascular and respiratory Emergency Department (ED) visits and hospitalizations and Sulfur Dioxide (SO₂) and particulate matter with an aerodynamic diameter ≤ 10 µm (PM₁₀) was determined.

METHODS

The records of a total of 632,223 people diagnosed with cardiovascular diseases (ICD-10 code I00-I99) and respiratory diseases (ICD-10 code J00-J99) at and over the age of 18 between 2012 and 2018 in three hospitals in Karaman in Turkey were examined in the present study. The daily 24-h averages for SO₂ and PM₁₀ concentrations were acquired in National Air Quality Monitoring. A time-series analysis with Poisson Generalized Linear Model was used.

RESULTS

Among the air pollution parameters, the mean ± standard deviation of SO₂ and PM₁₀ were 16.2 ± 22.1 and 75.8 ± 48.2 μg/m³, respectively. An increase of 10 μg/m³ in SO₂ was associated with a 3% [Relative Risk (RR), 95% Confidence Interval (CI): 2-4)] increase in cardiovascular ED visit and 2% (RR, 95% CI 2-3) increase in respiratory ED visit, and 1% (RR, 95% CI 1-3) increase in respiratory hospitalizations. An increase of 10 μg/m³ in PM₁₀ was associated with a 1% (RR, 95% CI 1-2) increase in cardiovascular hospitalizations.

CONCLUSIONS

Increases in SO₂ are a risk factor for cardiovascular and respiratory ED visits, and respiratory hospitalizations. Increases in PM₁₀ are a risk factor for cardiovascular hospitalizations.

The relationship between exposure to PM2.5 and atrial fibrillation in older adults: A systematic review and meta-analysis

Fine particle matter (PM_2.5) is recognized as atrial fibrillation (AF) risk factor, especially for older adults. However, studies on the relationship between PM_2.5 and AF were inconsistent. Herein, we present a systematic review to further assess the correlation between PM_2.5 and AF in older adults (average age > 50 years old). A comprehensive search was conducted with the keywords in PubMed (675 records), Web of Science (1130 records), Embase (82 records), and the Cochrane Library (42 records). Using Stata12.0 software to test the heterogeneity between studies, and select the corresponding model to calculate the comprehensive effect value, odds ratio (OR, odds ratio), the pooled %-change (percentage change) and its 95% confidence interval (CL, confidence interval). A total of 16 observational studies were included, involving 10,580,394 participants, the results showed that PM_2.5 had an adverse effects on AF in older adults. An association was found between exposure to PM_2.5 (per 10 μg/m³ increase) and AF in older adults, with the corresponding pooled OR (1.11, 95% CI: 1.03-1.19) and pooled %-change (1.01%, 95% CI: 0.14%-1.88%). Our study indicated that PM_2.5 exposure was significantly related to increased incidence of AF in older adults. Both the pooled OR and %-change value were higher in areas with higher levels of PM_2.5(≥25 μg/m³).

The Association Between Ambient Air Pollution and Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia; it has been known to increase the risk of stroke and heart failure. The association between air pollutants and AF has remained to be controversial. Thus, in this study, we sought to undertake a systematic review and meta-analysis in order to assess the short- and long-term effects of ambient air pollution on AF.We searched PubMed, Web of Science, Embase, and Ovid for all related studies up to October 2019. We used the random-effects model to estimate the excess risk percentage (ER%) and confidence intervals (CI) for particulate matter with diameter ≤ 2.5 (PM_2.5) and ≤ 10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), and carbon monoxide (CO). Results were further analyzed by subgroups according to location, age, outcome, and gender.In total, 18 studies were included in our meta-analysis: 5 evaluated for long-term effects, 12 for short-term effects, and 1 for both long- and short-term effects. For the short term, ER per 10 μg/m³ increase of pollutants was 1.8% (0%-3.7%) for PM_2.5 and 1.1% (-0.2%-2.4%) for PM₁₀; per 10 parts per billion (ppb) increment of gaseous pollutions was 3.2% (0.6%-5.8%) for NO₂, 2.9% (0.3%-5.7%) for SO₂, 0.5% (-3.4%-4.7%) for O₃, and 2.0% (-1.3%-5.4%) for CO per 1000 ppb change. The subgroup analysis showed the short-term effect was significantly different by region, gender, outcome, and age. Meanwhile, in the long term, except for O₃, a statistically significant association was noted between AF incidence and all pollutants.Our meta-analysis suggests that short-term exposure to part of pollutants (PM_2.5, SO₂, and NO₂) increases AF attack. Further, long-term exposure to air pollution can significantly contribute to the incidence of AF in a healthy population.

Social Risk Factors and Atrial Fibrillation

Modifiable risk factor management is becoming one of the 3 treatment pillars in atrial fibrillation management along with anticoagulation as well as conventional rate and rhythm control strategies. Preventive therapies, such as reducing blood pressure and treating obstructive sleep apnea, are paramount in the strategy of preventing atrial fibrillation. Identification of new modifiable risk factors and triggers also could help in the global strategy to reduce atrial fibrillation. This article covers alcohol intake, tobacco smoking, caffeine, chocolate, cannabis use, and air pollution as social risk factors related to lifestyle habits that potentially could contribute to atrial fibrillation development.

Cardiovascular effects of air pollution: current evidence from animal and human studies

Air pollution is a global health concern. Particulate matter (PM)_2.5, a component of ambient air pollution, has been identified by the World Health Organization as one of the pollutants that poses the greatest threat to public health. Cardiovascular health effects have been extensively documented, and these effects are still being researched to provide an overview of recent literature regarding air pollution-associated cardiovascular morbidity and mortality in humans. Additionally, potential mechanisms through which air pollutants affect the cardiovascular system are discussed based on human and additional animal studies. We used the strategy of a narrative review to summarize the scientific literature of studies that were published in the past 7 yr. Searches were carried out on PubMed and Web of Science using predefined search queries. We obtained an initial set of 800 publications that were filtered to 78 publications that were relevant to include in this review. Analysis of the literature showed significant associations between air pollution, especially PM_2.5, and the risk of elevated blood pressure (BP), acute coronary syndrome, myocardial infarction (MI), cardiac arrhythmia, and heart failure (HF). Prominent mechanisms that underlie the adverse effects of air pollution include oxidative stress, systemic inflammation, endothelial dysfunction, autonomic imbalance, and thrombogenicity. The current review underscores the relevance of air pollution as a global health concern that affects cardiovascular health. More rigorous standards are needed to reduce the cardiovascular disease burden imposed by air pollution. Continued research on the health impact of air pollution is needed to provide further insight.

Short-Term Effects of Air Pollution on Cardiovascular Hospitalizations in the Pisan Longitudinal Study

Air pollution effects on cardiovascular hospitalizations in small urban/suburban areas have been scantly investigated. Such effects were assessed among the participants in the analytical epidemiological survey carried out in Pisa and Cascina, Tuscany, Italy (2009–2011). Cardiovascular hospitalizations from 1585 subjects were followed up (2011–2015). Daily mean pollutant concentrations were estimated through random forests at 1 km (particulate matter: PM₁₀, 2011–2015; PM_2.5, 2013–2015) and 200 m (PM₁₀, PM_2.5, NO₂, O₃, 2013–2015) resolutions. Exposure effects were estimated using the case-crossover design and conditional logistic regression (odds ratio—OR—and 95% confidence interval—CI—for 10 μg/m³ increase; lag 0–6). During the period 2011–2015 (137 hospitalizations), a significant effect at lag 0 was observed for PM₁₀ (OR = 1.137, CI: 1.023–1.264) at 1 km resolution. During the period 2013–2015 (69 hospitalizations), significant effects at lag 0 were observed for PM₁₀ (OR = 1.268, CI: 1.085–1.483) and PM_2.5 (OR = 1.273, CI: 1.053–1.540) at 1 km resolution, as well as for PM₁₀ (OR = 1.365, CI: 1.103–1.690), PM_2.5 (OR = 1.264, CI: 1.006–1.589) and NO₂ (OR = 1.477, CI: 1.058–2.061) at 200 m resolution; significant effects were observed up to lag 2. Larger ORs were observed in males and in subjects reporting pre-existent cardiovascular/respiratory diseases. Combining analytical and routine epidemiological data with high-resolution pollutant estimates provides new insights on acute cardiovascular effects in the general population and in potentially susceptible subgroups living in small urban/suburban areas.

Association between air pollutants and atrial fibrillation in general population: A systematic review and meta-analysis

BACKGROUND

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with several risk factors. Recent studies have suggested that the exposure to air pollutants may increase the prevalence of AF, we evaluated those studies systematically to better elucidate the correlation between exposure to air pollution and AF.

METHOD

We conducted a systematic review of publications using PubMed, Embase, the Cochrane library and Web of Science to explore the association between air pollutants and AF within the general population. The chosen studies were published until 7 July 2020. According to different study designs, we divided the outcomes into "short-term-exposure group" and "long-term-exposure group" for each pollutant. We used I² statistics and Q-test to examine statistical heterogeneity, and sensitivity analysis to exclude the heterogeneous study. Fixed or random-effect model was used to combine the effects. Final result was presented as the OR and 95% CI of AF prevalence for every 10 μg/m³ increase in the concentration of PM_2.5 and PM₁₀;10 ppb increase in the concentration of SO₂ ,NO₂ ,O₃; and 1 ppm increase in the CO concentration.

RESULTS

Our analysis contain 18 studies. Underlying short-term exposure effect, for each increment of 10 μg/m³ in the PM_2.5 concentration, the combined OR of AF prevalence was 1.01(1.00-1.02), for PM₁₀ was 1.03(1.01-1.05). For a 10 ppb increment in the concentration of SO₂, NO₂, and O₃ was 1.05(1.01-1.09), 1.03(1.01-1.04), and 1.01(0.97-1.06), respectively, for a 1 ppm increase of CO concentration was 1.02(0.99-1.06). Underlying long-term-exposure effect for each increment of 10 μg/m³ in the PM_2.5 concentration; the combined OR of AF prevalence was 1.07(1.04-1.10) and that for PM₁₀ was 1.03(1.03-1.04) For a 10 ppb increment in the NO₂ concentration was 1.02(1.00-1.04).

CONCLUSION

Our meta-analysis indicated that all air pollutants exposure had an adverse effect on AF prevalence in general population.

Short-term effects of cold spells on hospitalisations for acute exacerbation of chronic obstructive pulmonary disease: a time-series study in Beijing, China

OBJECTIVES

Our work aimed at exploring the relationship between cold spells and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) hospitalisations in Beijing, China, and assessing the moderating effects of the intensities and the durations of cold spells, as well as identifying the vulnerable.

DESIGN

A time-series study.

SETTING

We obtained time-series data of AECOPD hospitalisations, meteorological variables and air quality index in Beijing, China during 2012-2016.

PARTICIPANTS

All AECOPD hospitalisations among permanent residents in Beijing, China during the cold seasons (November-March) of 2012-2016 were included (n=84 571).

PRIMARY AND SECONDARY OUTCOME MEASURES

A quasi-Poisson regression with a distributed lag model was fitted to investigate the short-term effects of cold spells on AECOPD hospitalisations by comparing the counts of AECOPD admissions during cold spell days with those during non-cold spell days.

RESULTS

Cold spells under different definitions were associated with increased risk of AECOPD hospitalisations, with the maximum cumulative relative risk (CRR) over 3 weeks (lag0-21). The cumulative effects at lag0-21 increased with the intensities and the durations of cold spells. Under the optimal definition, the most significant single-day relative risk (RR) was found on the days of cold spells (lag0) with an RR of 1.042 (95% CI 1.013 to 1.072), and the CRR at lag0-21 was 1.394 (95% CI 1.193 to 1.630). The elderly (aged ≥65) were more vulnerable to the effects of cold spells on AECOPD hospitalisations.

CONCLUSION

Cold spells are associated with increased AECOPD hospitalisations in Beijing, with the cumulative effects increased with intensities and durations. The elderly are at particular risk of AECOPD hospitalisations triggered by cold spells.

Short-term effects of particulate matter on cardiovascular morbidity in Italy: a national analysis

AIMS

We aimed at investigating the relationship between particulate matter (PM) and daily admissions for cardiovascular diseases (CVDs) at national level in Italy.

METHODS AND RESULTS

Daily numbers of cardiovascular hospitalizations were collected for all 8084 municipalities of Italy, in the period 2013-2015. A satellite-based spatiotemporal model was used to estimate daily PM10 (inhalable particles) and PM2.5 (fine particles) concentrations at 1-km2 resolution. Multivariate Poisson regression models were fit to estimate the association between daily PM and cardiovascular admissions. Flexible functions were estimated to explore the shape of the associations at low PM concentrations, also in non-urban areas. We analysed 2 154 810 acute hospitalizations for CVDs (25% stroke, 24% ischaemic heart diseases, 22% heart failure, and 5% atrial fibrillation). Relative increases of total cardiovascular admissions, per 10 µg/m3 variation in PM10 and PM2.5 at lag 0-5 (average of last 6 days since admission), were 0.55% (95% confidence intervals: 0.32%, 0.77%) and 0.97% (0.67%, 1.27%), respectively. The corresponding estimates for heart failure were 1.70% (1.28%, 2.13%) and 2.66% (2.09%, 3.23%). We estimated significant effects of PM10 and PM2.5 also on ischaemic heart diseases, myocardial infarction, atrial fibrillation, and ischaemic stroke. Associations were similar between less and more urbanized areas, and persisted even at low concentrations, e.g. below WHO guidelines.

CONCLUSION

PM was robustly associated with peaks in daily cardiovascular admissions, especially for heart failure, both in large cities and in less urbanized areas of Italy. Current WHO Air Quality Guidelines for PM10 and PM2.5 are not sufficient to protect public health.

Temporal variations of short-term effects of particulate matter on hospital admissions in the most densely populated city in Thailand

Short-term effects of ambient particulate matter (PM) on daily hospital admissions have been comprehensively elucidated, but very few studies evaluated the temporal variations of ambient PM associated with hospital admissions, especially in developing countries. This study aimed to explore the temporal changes of the short-term effects of PM₁₀ on hospital admissions in Bangkok, Thailand from 2006 to 2014. The overdispersed Poisson regression model was applied to related daily PM₁₀ concentrations to daily cardiovascular and respiratory hospital admissions by adjusting for temperature, humidity, long-term trend and seasonality, day of the week, public holiday, and population dynamics. The temporal variations of the effects of PM₁₀ on hospital admissions were assessed by adding an interaction term between PM₁₀ concentration and predefined time periods into the model. The relative risks per 10 μg/m³ increase in PM₁₀ were 1.0092 (95% CI: 1.0046, 1.0138) for cardiovascular admissions at lag 0-3 day and 1.0209 (95% CI: 1.0145, 1.0273) for respiratory admissions at lag 0-7 day over the entire study period. Despite non-homogenous decreasing trends in annual PM₁₀ concentrations during the study period, the effects of PM₁₀ on cardiovascular and respiratory admissions remained significant and even showed an increasing trend for cardiovascular admissions. Specifically, the relative risks of cardiovascular admission per 10 μg/m³ increase in PM₁₀ were 1.0050 (95% CI: 0.9965, 1.0135), 1.0086 (95% CI: 1.0000, 1.0174), and 1.0103 (95% CI: 1.0041, 1.0165) for the period of 2006-2008, 2009-2011, and 2012-2014, respectively (p-value for interaction <0.01). This finding indicated that estimated effects of PM₁₀ on cardiovascular admissions significantly changed over time, speculating that the composition of PM₁₀ might have changed and introduced the alterations of overall toxicity of PM₁₀. Therefore, the efforts on air pollution control need to be continued to reduce health effects of PM₁₀ in the future.

Association between fine particulate matter and atrial fibrillation in implantable cardioverter defibrillator patients: a systematic review and meta-analysis

PURPOSE

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with several risk factors. Recent studies have suggested that the exposure to fine particulate matter (PM_2.5) increased the incidence of AF, but there is no meta-analysis of AF occurrence due to the exposure to PM_2.5 in implantable cardioverter defibrillator (ICD) patients.

METHODS

We conducted a systematic review of publication using PubMed, Embase, the Cochrane library, and Web of Science to explore the association between PM_2.5 and AF within ICD patients. The chosen studies were published until June 11, 2020. The I² statistic and Q test were used to examine statistical heterogeneity across studies. Further sensitivity analyses were carried out to ascertain the reason for heterogeneity. Fixed or random-effect model was used to combine the effects. Final result was presented as the OR with 95% CI of increased incidence of AF for every 10 μg/m³ PM_2.5 concentration increased.

RESULTS

After screening our analysis contained four studies and involved 1689 AF events from 572 patients. After using the random-effect model to combine the included study result, the overall OR was 1.24 (95% CI 1.00-1.53).

CONCLUSION

Our meta-analysis indicated that PM_2.5 exposure had an adverse effect on AF incidence in ICD patients.

Daily Exposure to Air Pollution Particulate Matter Is Associated with Atrial Fibrillation in High-Risk Patients

Several epidemiological studies found an association between acute exposure to fine particulate matter of less than 2.5 μm and 10 μm in aerodynamic diameter (PM_2.5 and PM₁₀) and cardiovascular diseases, ventricular fibrillation incidence and mortality. The effects of pollution on atrial fibrillation (AF) beyond the first several hours of exposure remain controversial. A total of 145 patients with implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy defibrillators (ICD-CRT), or pacemakers were enrolled in this multicentric prospective study. Daily levels of PM_2.5 and PM₁₀ were collected from monitoring stations within 20 km of the patient’s residence. A Firth Logistic Regression model was used to evaluate the association between AF and daily exposure to PM_2.5 and PM₁₀. Exposure levels to PM_2.5 and PM₁₀ were moderate, being above the World Health Organization (WHO) PM_2.5 and PM₁₀ thresholds of 25 μg/m³ and 50 μg/m³, respectively, on 26% and 18% of the follow-up days. An association was found between daily levels of PM_2.5 and PM₁₀ and AF (95% confidence intervals (CIs) of 1.34–2.40 and 1.44–4.28, respectively) for an increase of 50 µg/m³ above the WHO threshold. Daily exposure to moderate PM_2.5 and PM₁₀ levels is associated with AF in patients who are not prone to AF.

Short-term exposure to PM2.5 and risk of venous thromboembolism: A case-crossover study

BACKGROUND

Short-term exposure to air pollution increases the risk of cardiovascular mortality and morbidity but little evidence is available on pollution effects on venous thromboembolism (VTE), a common vascular disease.

METHODS

We conducted a case-crossover analysis of all urgent hospitalizations for deep vein thrombosis (DVT) or pulmonary embolism (PE) among patients >35 years during the period 2006 to 2017 in Rome (Italy). We examined whether 1) short-term exposure to particulate matter with aerodynamic diameter <2.5 μg (PM_2.5) increases the risk of hospitalization for DVT or PE, and 2) if the associations are modified by the period of the year (warm and cold seasons), sex, age and comorbidity.

RESULTS

We found that short-term exposure to PM_2.5 was associated with an increase of PE hospitalization risk of during the warm season (April to September) of 19.6% (95% confidence intervals: 8.3, 31%) per 10 μg/m³, while no statistically significant effects were displayed during the cold season or the whole year or for DVT hospitalizations. The effect of PM_2.5 remained significant (%change: 21.3; 95%CI: 5.4, 39.5) after adjustment for nitrogen dioxide (NO₂) co-exposure (a marker of traffic sources) and when limiting to primary diagnosis of PE (%change: 19.1; 95%CI: 4.2, 36.1). Age, sex and comorbid conditions did not modify the association.

CONCLUSIONS

Our results suggested a positive association between short-term exposure to PM_2.5 and pulmonary embolism during the warm period of the year while no evidence emerged for deep vein thrombosis.