Influence of Meteorological Temperature and Pressure on the Severity of Heart Failure Decompensations

Òscar Miró; Miguel Benito-Lozano; Pedro Lopez-Ayala; Sergio Rodríguez; Pere Llorens; Ana Yufera-Sanchez; Javier Jacob; Lissete Traveria; Ivo Strebel; Víctor Gil; Josep Tost; Maria de Los Angeles López-Hernández; Aitor Alquézar-Arbé; Begoña Espinosa; Christian Mueller; Guillermo Burillo-Putze; ICA-SEMES group

doi:10.1007/s11606-022-07743-7

Influence of Meteorological Temperature and Pressure on the Severity of Heart Failure Decompensations

J Gen Intern Med. 2023 Feb;38(3):600-609. doi: 10.1007/s11606-022-07743-7. Epub 2022 Aug 8.

Authors

Òscar Miró^{1

2}, Miguel Benito-Lozano³, Pedro Lopez-Ayala^{4

5}, Sergio Rodríguez^{6

7}, Pere Llorens⁸, Ana Yufera-Sanchez⁵, Javier Jacob⁹, Lissete Traveria³, Ivo Strebel⁵, Víctor Gil¹⁰, Josep Tost¹¹, Maria de Los Angeles López-Hernández³, Aitor Alquézar-Arbé¹², Begoña Espinosa⁸, Christian Mueller^{4

5}, Guillermo Burillo-Putze¹³; ICA-SEMES group

Affiliations

¹ Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, c/ Villarroel 170, 08036, Barcelona, Catalonia, Spain. omiro@clinic.cat.
² The GREAT Network, Rome, Italy. omiro@clinic.cat.
³ Emergency Department, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, Spain.
⁴ The GREAT Network, Rome, Italy.
⁵ Cardiovascular Research Institute Basel (CRIB) and Cardiology Department, University Hospital Basel, University of Basel, Basel, Switzerland.
⁶ Instituto de Productos Naturales y Agrobiología, IPNA CSIC, Santa Cruz de Tenerife, Tenerife, Canary Islands, Spain.
⁷ Estación Experimental de Zonas Áridas, EEZA CSIC, Almería, Spain.
⁸ Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain.
⁹ Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
¹⁰ Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, c/ Villarroel 170, 08036, Barcelona, Catalonia, Spain.
¹¹ Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain.
¹² Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain.
¹³ Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Tenerife, Spain.

Abstract

Objective: To investigate the relationship between ambient temperature and atmospheric pressure (AP) and the severity of heart failure (HF) decompensations.

Methods: We analysed patients coming from the Epidemioloy Acute Heart Failure Emergency (EAHFE) Registry, a multicentre prospective cohort study enrolling patients diagnosed with decompensated HF in 26 emergency departments (EDs) of 16 Spanish cities. We recorded patient and demographic data and maximum temperature (T_max) and AP (AP_max) the day before ED consultation. Associations between temperature and AP and severity endpoints were explored by logistic regression. We used restricted cubic splines to model continuous non-linear associations of temperature and AP with each endpoint.

Results: We analysed 16,545 patients. Daily T_max and AP_max (anomaly) of the day before patient ED arrival ranged from 0.8 to 41.6° and from - 61.7 to 69.9 hPa, respectively. A total of 12,352 patients (75.2%) were hospitalised, with in-hospital mortality in 1171 (7.1%). The probability of hospitalisation by HF decompensation showed a U-shaped curve versus T_max and an increasing trend versus AP_max. Regarding temperature, hospitalisation significantly increased from 20 °C (reference) upwards (25 °C: OR = 1.12, 95% CI = 1.04-1.21; 40 °C: 1.65, 1.13-2.40) and below 5.4 °C (5 °C: 1.21, 1.01-1.46). Concerning the mean AP of the city (anomaly = 0 hPa), hospitalisation increased when AP_max (anomaly) was above + 7.0 hPa (atmospheric anticyclone; + 10 hPa: 1.14, 1.05-1.24; + 30 hPa: 2.02. 1.35-3.03). The lowest probability of mortality also corresponded to cold-mild temperatures and low AP, with a significant increased risk only found for T_max above 24.3 °C (25 °C: 1.13, 1.01-1.27; 40 °C: 2.05, 1.15-3.64) and AP_max (anomaly) above + 3.4 hPa (+ 10 hPa: 1.21, 1.07-1.36; + 30 hPa: 1.73, 1.06-2.81). Sensitivity analysis confirmed the main analysis results.

Conclusion: Temperature and AP are independently associated with the severity of HF decompensations, with possible different effects on the need for hospitalisation and in-hospital mortality.

Keywords: acute heart failure; atmospheric pressure; climate; emergency departments; mortality; temperature.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Emergency Service, Hospital
Heart Failure* / diagnosis
Hospitalization
Humans
Prospective Studies
Temperature