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Short-term Effects of Fine Particulate Matter on Heart Rate in Heart Failure Patients
Citation:
Breen, M., W. Cascio, J. Moyer, J. Schwartz, Q. Di, E. Pfaff, R. Devlin, D. Diaz-Sanchez, AND C. Ward-Caviness. Short-term Effects of Fine Particulate Matter on Heart Rate in Heart Failure Patients. International Society of Environmental Epidemiology 2020 Virtual Meeting (ISEE), Virtual, Virtual, August 23 - 27, 2020. https://doi.org/10.23645/epacomptox.13268816
Impact/Purpose:
We used the EPA CARES resource to examine the association between short-term PM2.5 exposure and heart rate (HR) in heart failure (HF) patients. We analyzed 3,048,856 heart rate (HR) measurements on 26,634 HF patients between January 2014 and December 2016, compiled using the Epic electronic health records from University of North Carolina affiliated hospitals.
Description:
Air pollution is one of the most significant risk factors for cardiovascular disease globally. Studies have found associations between ambient fine particulate matter (PM2.5) and cardiovascular morbidity, but the results have been primarily based on the general, typically healthy, population and there is limited information for individuals with pre-existing disease. We used the EPA CARES resource to examine the association between short-term PM2.5 exposure and heart rate (HR) in heart failure (HF) patients. Additionally, we examine potential interactions with the beta-blockers, a common medication class that modifies HR. Methods: We analyzed 3,048,856 heart rate (HR) measurements on 26,634 HF patients between January 2014 and December 2016, compiled using the Epic electronic health records from University of North Carolina affiliated hospitals. Immediate (lag 0), delayed (lag 1 to 4), or cumulative (5 day moving average, 5dMA) daily average concentrations of PM2.5 for each HR measurements were predicted at the primary address for each patient using a 1km resolution model incorporating satellite, land use, and ground-based monitoring data. Generalized additive mixed models were used to determine the association between PM2.5 and HR while adjusting for age, sex, race, season, time-trend, daily temperature, and relative humidity. Results: In the entire population, PM2.5 exposure was weakly associated with increases in HR for lag 2 and 3 (beta = 0.006, CI = 0.002, 0.009; beta = 0.005, CI = 0.002, 0.010). For individuals not taking beta-blocker medications at any time prior to HR measurement, we observed strong, positive associations of increased PM2.5 and HR were observed for lag 0 to 4 and 5dMA, with associations strongest at 5dMA (beta = 0.086, CI = 0.073, 0.099). Conclusions: Elevated PM2.5 is associated with increased HR in HF patients. Associations are at best weak for the entire population, but strong and consistent across lags for measurements prior to beginning beta-blockers, suggesting that beta-blocker medication regimes may substantially attenuate effects of PM2.5 on HR. This abstract does not necessarily reflect the policies of the U.S. EPA.
URLs/Downloads:
DOI: Short-term Effects of Fine Particulate Matter on Heart Rate in Heart Failure Patients
ISEEE 2020 POSTER V4 BREEN.PDF (PDF, NA pp, 608.377 KB, about PDF)