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Environmental factors, winter respiratory infections and the seasonal variation in heart failure admissions.

ABSTRACT: Seasonal cycles of AHF are causally attributed to the seasonal pattern of respiratory tract infections. However, this assumption has never been formally validated. We aimed to determine whether the increase in winter admissions for acute heart failure (AHF) can be explained by seasonal infectious diseases. We studied 12,147 patients admitted for AHF over a period of 11 years (2005-2015). Detailed virology and bacteriology data were collected on each patient. Meteorological information including daily temperature and relative humidity was obtained for the same period. The peak-to-low ratio, indicating the intensity of seasonality, was calculated using negative binomial regression-derived incidence rate ratios (IRR). AHF admissions occurred with a striking annual periodicity, peaking in winter (December-February) and were lowest in summer (June-August), with a seasonal amplitude (January vs. August) of 2.00 ([95% CI 1.79-2.24]. Occurrence of confirmed influenza infections was low (1.59%). Clinical diagnoses of respiratory infections, confirmed influenza infections, and influenza-like infections also followed a strong seasonal pattern (P < 0.0001; Peak/low ratio 2.42 [95% CI 1.394-3.03]). However, after exclusion of all respiratory infections, the seasonal variation in AHF remained robust (Peak/low ratio January vs. August, 1.81 [95% CI 1.60-2.05]; P < 0.0001). There was a strong inverse association between AHF admissions and average monthly temperature (IRR 0.95 per 1℃ increase; 95% CI 0.94 to 0.96). In conclusion, these is a dominant seasonal modulation of AHF admissions which is only partly explained by the incidence of winter respiratory infections. Environmental factors modify the susceptibility of heart failure patients to decompensation.

SUBMITTER: Aronson D

PROVIDER: S-EPMC8163784 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeThis study examined whether implementation of a heart failure (HF) education class targeted at patients and their caregivers decreased worsening HF, emergency department (ED) visits and hospital admissions, and improved patient quality of life and confidence in disease state management.MethodsPatients with HF and a recent hospital admission for acute decompensated heart failure (ADHF) were offered an educational course covering HF pathophysiology, medications, diet, and lifestyle modifications. Patients completed surveys before and 30 days after completion of the educational course. Outcomes of participants at 30 and 90 days after class completion were compared against outcomes for the same patients at 30 and 90 days prior to course attendance. Data was collected using electronic medical records, in-person during the class, and during a phone follow-up.ResultsThe primary outcome was a composite of hospital admission, ED visit, and/or outpatient visit for HF at 90 days. A total of twenty-six patients attended classes between September 2018 and February 2019 and were included in the analysis. Median age was 70 years, and most patients were white. All patients were American College of Cardiology/American Heart Association (ACC/AHA) Stage C and a majority had New York Heart Association (NYHA) Class II or III symptoms. Median left ventricular ejection fraction (LVEF) was 40%. The primary composite outcome occurred significantly more frequently in the 90 days prior to class attendance than in the 90 days following attendance (96% vs. 35%, p < 0.01). Likewise, the secondary composite outcome occurred significantly more frequently in the 30 days before class attendance than in the 30 days following (54% vs. 19%, p = 0.02). These results were driven by a decrease in admissions and ED visits for HF symptoms. Survey scores related to patient HF self-management practices and patient confidence in ability to self-manage HF increased numerically from baseline to 30 days after class attendance.ConclusionImplementation of an educational class for HF patients improved patient outcomes, confidence, and ability to self-manage HF. Hospital admissions and ED visits also decreased. Adoption of such a course might help to decrease overall health care costs and improve patient quality of life.

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Environmental factors, winter respiratory infections and the seasonal variation in heart failure admissions.

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