Influence of Meteorological Temperature and Pressure on the Severity of Heart Failure Decompensations

Abstract

Objective: To investigate the relationship between ambient temperature and atmospheric pressure (AP) and the severity of heart failure (HF) decompensations.

Methods: We analysed patients coming from the Epidemioloy Acute Heart Failure Emergency (EAHFE) Registry, a multicentre prospective cohort study enrolling patients diagnosed with decompensated HF in 26 emergency departments (EDs) of 16 Spanish cities. We recorded patient and demographic data and maximum temperature (T_max) and AP (AP_max) the day before ED consultation. Associations between temperature and AP and severity endpoints were explored by logistic regression. We used restricted cubic splines to model continuous non-linear associations of temperature and AP with each endpoint.

Results: We analysed 16,545 patients. Daily T_max and AP_max (anomaly) of the day before patient ED arrival ranged from 0.8 to 41.6° and from - 61.7 to 69.9 hPa, respectively. A total of 12,352 patients (75.2%) were hospitalised, with in-hospital mortality in 1171 (7.1%). The probability of hospitalisation by HF decompensation showed a U-shaped curve versus T_max and an increasing trend versus AP_max. Regarding temperature, hospitalisation significantly increased from 20 °C (reference) upwards (25 °C: OR = 1.12, 95% CI = 1.04-1.21; 40 °C: 1.65, 1.13-2.40) and below 5.4 °C (5 °C: 1.21, 1.01-1.46). Concerning the mean AP of the city (anomaly = 0 hPa), hospitalisation increased when AP_max (anomaly) was above + 7.0 hPa (atmospheric anticyclone; + 10 hPa: 1.14, 1.05-1.24; + 30 hPa: 2.02. 1.35-3.03). The lowest probability of mortality also corresponded to cold-mild temperatures and low AP, with a significant increased risk only found for T_max above 24.3 °C (25 °C: 1.13, 1.01-1.27; 40 °C: 2.05, 1.15-3.64) and AP_max (anomaly) above + 3.4 hPa (+ 10 hPa: 1.21, 1.07-1.36; + 30 hPa: 1.73, 1.06-2.81). Sensitivity analysis confirmed the main analysis results.

Conclusion: Temperature and AP are independently associated with the severity of HF decompensations, with possible different effects on the need for hospitalisation and in-hospital mortality.

Keywords: acute heart failure; atmospheric pressure; climate; emergency departments; mortality; temperature.

Fig. 1

Distribution of patients, according to the maximum atmospheric pressure of the day before arrival to the emergency department, considering all cities together (upper image) and individually (lower image).

Fig. 2

Distribution of patients, according to daily maximum temperature values (left) and maximum atmospheric pressure anomaly (right) of the day before patient arrival to the ED.

Fig. 3

Adjusted effects of temperature and atmospheric pressure on the need for hospitalisation of patients with AHF. Upper panels correspond to restricted cubic spline curves for predicted probabilities, and middle panels correspond to the odds ratio of hospitalisation for every temperature and atmospheric pressure value, choosing as reference a temperature value of 20 °C and an atmospheric pressure value of 0 HPa. The bottom panel corresponds to the heat map for probability of hospitalisation according to temperature and atmospheric pressure [inside, dot plot including the whole range of temperatures (from 0.8 to 41.6 °C) and atmospheric pressure anomalies (from − 61.7 to 69.9 hPa)]. The multivariable regression model was adjusted for median age (82 years), gender (reference Female), weekday (reference Monday), season (reference Winter), climate (reference Mediterranean), hypertension, diabetes mellitus, chronic kidney disease, coronary heart disease, cerebrovascular disease, and chronic obstructive pulmonary disease (for all risk factors, the reference was No).

Fig. 4

Adjusted effects of temperature and atmospheric pressure on in-hospital all-cause mortality of patients with AHF. Upper panels correspond to restricted cubic spline curves for predicted probabilities, and middle panels correspond to the odds ratio of mortality for every temperature and atmospheric pressure value, choosing as reference a temperature value of 20 °C and an atmospheric pressure value of 0 HPa. The bottom panel corresponds to the heat map for probability of mortality according to temperature and atmospheric pressure [inside, dots plot including the whole range of temperatures (from 0.8 to 41.6 °C) and atmospheric pressures (from − 61.7 to 69.9 hPa)]. The multivariable regression model was adjusted for median age (82 years), gender (reference Female), weekday (reference Monday), season (reference Winter), climate (reference Mediterranean), hypertension, diabetes mellitus, chronic kidney disease, coronary heart disease, cerebrovascular disease, and chronic obstructive pulmonary disease (for all risk factors, the reference was No).