Short-term PM2.5 exposure and early-readmission risk: a retrospective cohort study in North Carolina heart failure patients - 28/04/22
Riassunto |
Background |
Short-term changes in ambient fine particulate matter (PM2.5) increase the risk for unplanned hospital readmissions. However, this association has not been fully evaluated for high-risk patients or examined to determine if the readmission risk differs based on time since discharge. Here we investigate the relation between ambient PM2.5 and 30-day readmission risk in heart failure (HF) patients using daily time windows and examine how this risk varies with respect to time following discharge.
Methods |
We performed a retrospective cohort study of 17,674 patients with a recorded HF diagnosis between 2004 and 2016. The cohort was identified using the EPA CARES electronic health record resource. The association between ambient daily PM2.5 (μg/m3) concentration and 30-day readmissions was evaluated using time-dependent Cox proportional hazard models. PM2.5 associated readmission risk was examined throughout the 30-day readmission period and for early readmissions (1-3 days post-discharge). Models for 30-day readmissions included a parametric continuous function to estimate the daily PM2.5 associated readmission hazard. Fine-resolution ambient PM2.5 data were assigned to patient residential address and hazard ratios are expressed per 10 μg/m3 of PM2.5. Secondary analyses examined potential effect modification based on the time after a HF diagnosis, urbanicity, medication prescription, comorbidities, and type of HF.
Results |
The hazard of a PM2.5-related readmission within 3 days of discharge was 1.33 (95% CI 1.18-1.51). This PM2.5 readmission hazard was slightly elevated in patients residing in non-urban areas (1.43, 95%CI 1.22-1.67) and for HF patients without a beta-blocker prescription prior to the readmission (1.35; 95% CI 1.19-1.53).
Conclusion |
Our findings add to the evidence indicating substantial air quality-related health risks in individuals with underlying cardiovascular disease. Hospital readmissions are key metrics for patients and providers alike. As a potentially modifiable risk factor, air pollution-related interventions may be enacted that might assist in reducing costly and burdensome unplanned readmissions.
Il testo completo di questo articolo è disponibile in PDF.Graphical Abstract |
Mappa
Vol 248
P. 130-138 - Giugno 2022 Ritorno al numero
Articolo precedente
- Surrogate markers of gut dysfunction are related to heart failure severity and outcome–from the BIOSTAT-CHF consortium
- Muhammad Zubair Israr, Hong Zhan, Andrea Salzano, Adriaan A Voors, John G Cleland, Stefan D Anker, Marco Metra, Dirk J van Veldhuisen, Chim C Lang, Faiez Zannad, Nilesh J Samani, Leong L Ng, Toru Suzuki, BIOSTAT-CHF investigators (full author list as appendix)
- Improved outcomes in patients with severely depressed LVEF undergoing percutaneous coronary intervention with contemporary practices
- William W. O'Neill, Mark Anderson, Daniel Burkhoff, Cindy L. Grines, Navin K. Kapur, Alexandra J. Lansky, Salvatore Mannino, James M. McCabe, Khaldoon Alaswad, Ramesh Daggubati, David Wohns, Perwaiz M. Meraj, Duane S. Pinto, Jeffrey J. Popma, Jeffrey W. Moses, Theodore L. Schreiber, E. Magnus Ohman
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?