Case-Crossover Analysis of Short-Term Particulate Matter and Health Outcomes in Patients With Atrial Fibrillation

Area of Science:

• Environmental Health
• Cardiovascular Medicine
• Public Health

Background:

• Western US residents face increased fine particulate matter (PM2.5) exposure due to wildfires.
• This exposure raises concerns about cardiovascular risks, particularly for individuals with atrial fibrillation (AF).
• The impact of short-term PM2.5 on AF-related hospitalizations and emergency care is not well understood.

Purpose of the Study:

• To investigate the association between short-term PM2.5 exposure and cardiovascular outcomes in patients with established AF.
• To determine if elevated PM2.5 levels increase the odds of hospitalization or emergency department visits for AF patients.

Main Methods:

• Utilized 2021 Medicare data for patients with established AF in western US states.
• Estimated daily PM2.5 concentrations using a 1 km² geospatial model; defined high PM2.5 as ≥9.0 μg/m³.
• Employed conditional logistic regression to calculate odds ratios for hospitalizations and emergency visits at various lags, adjusting for extreme heat and holidays.

Main Results:

• The study included 26,158 AF patients (mean age 79 years).
• High PM2.5 exposure was linked to a 10% increased odds of cardiovascular disease hospitalizations.
• Significant increases were observed in AF-related hospitalizations (24%) and emergency visits (34%) on high PM2.5 days.

Conclusions:

• Elevated PM2.5 levels are associated with increased odds of AF-related and cardiovascular hospitalizations and emergency visits.
• These findings underscore the vulnerability of AF patients to air pollution.
• Targeted prevention strategies are crucial to mitigate adverse effects of air pollution on this population.