Abstract
Despite the large prevalence in the population, possible factors responsible for the induction of atrial fibrillation (AF) events in susceptible individuals remain incompletely understood. We investigated the association between air pollution levels and emergency department admissions for AF in Rome. We conducted a 14 years’ time-series study to evaluate the association between the daily levels of air pollution (particulate matter, PM10 and PM2.5, and nitrogen dioxide, NO2) and the daily count of emergency accesses for AF (ICD-9 code: 427.31). We applied an over-dispersed conditional Poisson model to analyze the associations at different lags after controlling for time, influenza epidemics, holiday periods, temperature, and relative humidity. Additionally, we evaluated bi-pollutant models by including the other pollutant and the influence of several effect modifiers such as personal characteristics and pre-existing medical conditions. In the period of study, 79,892 individuals were admitted to the emergency departments of Rome hospitals because of AF (on average, 15.6 patients per day: min = 1, max = 36). Air pollution levels were associated with increased AF emergency visits within 24 h of exposure. Effect estimates ranged between 1.4% (0.7–2.3) for a 10 µg/m3 increase of PM10 to 3% (1.4–4.7) for a 10 µg/m3 increase of PM2.5 at lag 0–1 day. Those effects were higher in patients ≥75 years for all pollutants, male patients for PM10, and female patients for NO2. The presence of previous cardiovascular conditions, but not other effect modifiers, increase the pollution effects by 5–8% depending on the lag. This study found evidence that air pollution is associated with AF emergency visits in the short term.
Highlights
Epidemiological evidences of the association between air pollution and cardiovascular diseases (CVD) have been growing in the last few decades [1,2,3]
For the case-only analysis, we reported results as interaction rate ratios (IRRs) estimating the Risk Ratios (RRs) for atrial fibrillation (AF) occurrence per 10 μg/m3 increases of pollutant concentration in persons who held the medical condition compared to persons who did not have the medical condition
During the period from 2001 to 2014, 79,892 individuals were admitted to emergency departments of Rome hospitals because of AF
Summary
Epidemiological evidences of the association between air pollution and cardiovascular diseases (CVD) have been growing in the last few decades [1,2,3]. Pooled estimates of the percent increase in CVD mortality, derived from meta-analyses and multiple city studies, range between 0.6 and 1.4 for any 10 μg/m3 increment of particulate matter (PM10 and PM2.5 ) [4]. CVD hospital admissions are reported to increase with the level of pollution [5,6]. A recent meta-analysis concluded that the risk of myocardial infarction (MI) increases significantly with all air pollutants screened, except for ozone [7]. One of the plausible mechanisms to explain the causal link between exposure to air pollution and increased CVD mortality and hospital admissions is through an adverse effect of inhaled pollutants on the cardiac autonomic control [9,10]. Previous studies showed that PM2.5 exposure was associated with increased heart rate and decreased heart rate variability [11], both markers of autonomic
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