Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen 518057, Guangdong Province, China; National Clinical Research Center for Cardiovascular Diseases, Shenzhen, Shenzhen 518057, Guangdong Province, China.
National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Ecotoxicol Environ Saf. 2021 Oct 1;222:112517. doi: 10.1016/j.ecoenv.2021.112517. Epub 2021 Jul 22.
BACKGROUND: The health effects of air pollution on heart failure (HF) patients have not been adequately studied. OBJECTIVES: We assessed the associations between long-term air pollution exposure and prognosis in HF patients. METHODS: HF patients were prospectively recruited from 52 hospitals throughout China between August 2016 and May 2018. The participants were followed up for 12 months after discharge from index hospitalization. Long-term air pollution was calculated as annual average level of air pollution before the date of the index hospitalization. Outcomes were defined as HF readmission, cardiovascular death, and composite events. Cox proportional hazards model was applied to quantify the associations between air pollution exposure and clinical outcomes. RESULTS: Of 4866 patients included in the analysis, mean age was 65.2 ± 13.5 years, and 62.5% were male. During 1-year follow-up, 1577 (32.4%) participants were readmitted for HF and 550 (11.3%) died from cardiovascular disease. Though no associations between long-term air pollution and HF readmission in the overall participants, geographic and age heterogeneity in the long-term effects of air pollutants on HF readmission was observed. Air pollutants included PM [HR (hazard ratio) = 1.146, 95% CI (confidence interval): 1.044, 1.259], PM (HR = 1.120, 95% CI: 1.043, 1.203), SO (HR = 1.808, 95% CI: 1.190, 2.747), and CO (HR = 3.596, 95% CI: 1.792, 7.218) were associated with higher risk of HF readmission in South China, but not in North China, where people spend less time outdoors and have limited indoor-outdoor ventilation. PM, PM O, and CO among patients ≥ 65 years were found to be associated with higher risk of HF readmission. The effects on composite outcomes were broadly consistent with that of HF readmission. Cardiovascular death was not significantly associated with air pollution in the overall or subgroups. DISCUSSION: Among HF patients who were older, living in South China, more HF readmissions occurred with higher long-term air pollution exposure. The findings suggest that the elderly patients and those living in South China should particularly enhance their personal protection against air pollution.
背景：空气污染对心力衰竭（HF）患者的健康影响尚未得到充分研究。
目的：我们评估了长期暴露于空气污染与 HF 患者预后之间的关系。
方法：2016 年 8 月至 2018 年 5 月期间，我们从中国 52 家医院前瞻性招募 HF 患者。参与者在出院后随访 12 个月。长期空气污染被计算为指数住院前的年度平均空气污染水平。结局定义为 HF 再入院、心血管死亡和复合事件。应用 Cox 比例风险模型来量化空气污染暴露与临床结局之间的关系。
结果：在纳入分析的 4866 例患者中，平均年龄为 65.2±13.5 岁，62.5%为男性。在 1 年随访期间，1577 例（32.4%）患者因 HF 再入院，550 例（11.3%）死于心血管疾病。尽管在总体参与者中未发现长期空气污染与 HF 再入院之间存在关联，但观察到了长期空气污染物对 HF 再入院的地理和年龄异质性。包括 PM（HR=1.146，95%CI：1.044，1.259）、PM（HR=1.120，95%CI：1.043，1.203）、SO（HR=1.808，95%CI：1.190，2.747）和 CO（HR=3.596，95%CI：1.792，7.218）在内的空气污染物与华南地区 HF 再入院风险增加相关，但在华北地区则不然，因为那里的人们户外活动时间较少，室内外通风有限。对于≥65 岁的患者，发现 PM、PM O 和 CO 与 HF 再入院风险增加相关。复合结局的影响与 HF 再入院的影响大致一致。心血管死亡与整体或亚组中的空气污染均无显著关联。
讨论：在年龄较大、居住在华南地区的 HF 患者中，随着长期空气污染暴露的增加，HF 再入院的发生率更高。这些发现表明，老年患者和居住在华南地区的患者应特别加强对空气污染的个人防护。
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