Òscar Miró1,2, Miguel Benito-Lozano3, Pedro Lopez-Ayala4,5, Sergio Rodríguez6,7, 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 Mueller4,5, Guillermo Burillo-Putze13. 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 (Tmax) and AP (APmax) 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 Tmax and APmax (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 Tmax and an increasing trend versus APmax. 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 APmax (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 Tmax above 24.3 °C (25 °C: 1.13, 1.01-1.27; 40 °C: 2.05, 1.15-3.64) and APmax (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.
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 (Tmax) and AP (APmax) 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 Tmax and APmax (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 Tmax and an increasing trend versus APmax. 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 APmax (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 Tmax above 24.3 °C (25 °C: 1.13, 1.01-1.27; 40 °C: 2.05, 1.15-3.64) and APmax (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.
Authors: Lluís Llauger; Javier Jacob; Luis Arturo Moreno; Alfons Aguirre; Enrique Martín-Mojarro; Juan Carlos Romero-Carrete; Gemma Martínez-Nadal; Josep Tost; Gerard Corominas-Lasalle; Àlex Roset; Carlos Cardozo; Guillem Suñén-Cuquerella; Brigitte Alarcón; Sergio Herrera-Mateo; José Carlos Ruibal; Aitor Alquézar-Arbé; Víctor Gil; Ruxandra Donea; Marta Berenguer; Pere Llorens; Bernat Villanueva-Cutillas; Francisco Javier Martín-Sánchez; Pablo Herrero; Òscar Miró Journal: Emergencias Date: 2020-09 Impact factor: 3.881