School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.
Circ Heart Fail. 2013 Sep 1;6(5):930-5. doi: 10.1161/CIRCHEARTFAILURE.113.000360. Epub 2013 Aug 9.
Although the seasonal variation and the effect of cold temperature on heart failure (HF) morbidity have been well documented, it is unknown whether the temperature variation within a day, that is, diurnal temperature range (DTR), is an independent risk factor for HF. We hypothesized that large DTR might be a source of additional environmental stress and, therefore, a risk factor for HF exacerbation. We aimed to test the association between DTR and HF hospitalization and to examine the effect modifiers, such as age, sex, and season.
We collected daily meteorologic data and emergency HF hospital admissions from 2000 to 2007 in Hong Kong. We used Poisson regression models to fit the relationship between daily DTR and emergency HF hospitalizations, after adjusting for the time trend, seasonality, mean temperature, humidity, and levels of outdoor air pollution. We confirmed the seasonal variation of HF with peak hospital admissions in winter in Hong Kong. The adverse effects of DTR on emergency HF admissions were observed on the current day and lasted for the following several days. Every 1°C increase of DTR at lag0 corresponded to 0.86% (95% confidence interval, 0.31%-1.43%) increment of emergency hospital admissions for HF. DTR exhibited significantly greater effect in the cool season, and on female and elderly patients.
Greater temperature change within a day was associated with increased emergency hospital admissions for HF. Health policymakers and hospitals may want to take into account the increased demand of specific facilities for susceptive population in winter with greater daily temperature variations.
尽管季节性变化和低温对心力衰竭（HF）发病率的影响已有充分记录，但目前尚不清楚一天内的温度变化，即昼夜温差（DTR），是否是 HF 的独立危险因素。我们假设较大的 DTR 可能是额外环境压力的来源，因此是 HF 恶化的危险因素。我们旨在检验 DTR 与 HF 住院之间的关联，并研究年龄、性别和季节等影响修饰因子。
我们收集了 2000 年至 2007 年香港的每日气象数据和急诊 HF 住院数据。我们使用泊松回归模型，在调整了时间趋势、季节性、平均温度、湿度和室外空气污染水平后，拟合了每日 DTR 与急诊 HF 住院之间的关系。我们证实了 HF 在香港冬季的季节性变化，住院人数达到高峰。DTR 对急诊 HF 入院的不利影响在当前日观察到，并持续数天。滞后 0 时 DTR 每增加 1°C，急诊 HF 入院的增幅为 0.86%（95%置信区间，0.31%-1.43%）。DTR 在凉爽季节、女性和老年患者中表现出显著更大的影响。
一天内更大的温度变化与急诊 HF 入院人数的增加有关。卫生政策制定者和医院可能需要考虑在冬季日温差较大时，为易感人群增加特定设施的需求。
