The impact of increased exposure to regulated air pollutants on the severity of symptoms and mortality in patients with acute decompensated heart failure
M Jozwik, K Badura, A Baszkowski, M Nadel, A Misiewicz, J DrozdzAbstract
Background
Recent studies have shown that air pollutants exert a negative impact on the cardiovascular system. Research is currently conducted to determine their connection with acute decompensated heart failure (ADHF). Although their role is yet to be fully understood, preliminary findings suggest its contribution in inducing oxidative stress, inflammation and apoptosis which may be associated with exacerbation of heart failure (HF).
Purpose
The aim of this study was to assess the impact of regulated air pollutants, on patients hospitalized due to ADHF, in order to determine their role in ADHF development and its clinical presentation.
Methods
This was a single-centre retrospective study which enrolled 172 consecutive patients hospitalized due to ADHF between January 2024 and August 2024. We analysed demographic data, medical history, comorbidities, baseline symptoms and electrocardiogram, transthoracic echocardiogram, and laboratory test results during hospitalization. Concentrations of regulated air pollutants were obtained from available air-quality monitoring stations located closest to each of the patient’s places of residence. The measured concentrations were compared with established World Health Organization, European Union and national standards to assess patient’s exposure.
Results
Higher exposure to particular matter (PM10) within 7 days before admission was associated with higher New York Heart Association (NYHA) class on admission (median [IQR] for NYHA II, III and IV: 12.82 [12.06-17.57] vs. 17.16 [14.41-22.74] vs. 17.83 [14.76-26.75], respectively: p=0.04). Moreover, patients who reported orthopnoea and/or dyspnoea as a leading symptom, when compared to others, had higher exposure to following pollutants within 30 days before admission (Median [IQR]): PM2.5 (16.98 [7.13-19.36] vs. 9.18 [6.50-17.61], p=0.046); benzo[a]anthracene (3.07 [1.15-9.96] vs. 1.48 [0.07-3.27], p=0.02); benzo[a]pyrene (Ben(a)) (2.72 [0.66-4.00] vs. 1.17 [0.07-2.44], p=0.003); sulphur dioxide (2.91 [1.42-3.84] vs. 1.54 [0.81-3.09], p=0.004); arsenic (0.64 [0.50-0.80] vs. 0.52 [0.50-0.64], p=0.01); lead (0.007 [0.005-0.007] vs. 0.006 [0.003-0.007], p=0.02) and benzene (1.34 [0.58-1.46] vs. 0.72 [0.32-1.29], p=0.004). In patients exposed to concentration of PM2.5 on admission exceeding threshold of 8 mcg/m3 decreased survival was observed (log-rank p=0.04).
Conclusions
Higher PM10 concentrations during the 7 days preceding admission were associated with a higher NYHA class. Moreover, exposure to higher concentration levels of certain air pollutants including PM2.5, SO2, benzene, benzo[a]anthracene, ben(a), lead and arsenic can be associated with exacerbation of pulmonary oedema and orthopnoea. However, it is worth noting that there was no association between higher exposure and in-hospital death amongst patients hospitalized due to ADHF. These are the preliminary results that require further validation on a larger cohort.Figure 1 For image description, please refer to the figure legend and surrounding text.Figure 2 For image description, please refer to the figure legend and surrounding text.