Hospital Admissions For Cardiovascular Diseases Research Articles

Causes of hospitalization and prognosis in patients with cardiovascular diseases. Secular trends in the years 2006-2014 according to the SILesian CARDiovascular (SILCARD) database.

INTRODUCTION Despite the progress in cardiology in recent years, cardiovascular (CV) diseases remain the main cause of death in European countries. The knowledge concerning the structure of hospital admissions for CV diseases and clinical outcomes is fragmentary. OBJECTIVES The aim of the study was to analyze the characteristics and outcome of patients with CV disease, hospitalized between 2006 and 2014 and included in the Silesian Cardiovascular Database (SILCARD) covering a population of 4.6 million patients. PATIENTS AND METHODS SILCARD is based on the data from the Regional Department of the National Health Fund in Poland. The enrollment criteria were any hospitalization at a department of cardiology, cardiac surgery, diabetology or vascular surgery and hospitalization with a cardiovascular diagnosis at a department of internal medicine or intensive care. The data come from 310 hospital departments and 1863 outpatient clinics, and contain information on 487 518 patients and 956 634 hospitalizations. RESULTS Heart failure (20%) and stable coronary artery disease (18.5%) were the most frequent primary causes of hospitalization. The number of hospitalizations due to heart failure, aortic stenosis, and pulmonary embolism significantly increased. The highest 12‑month mortality was reported in patients with heart failure and pulmonary embolism (>30%). A decrease in 12‑month mortality in patients with heart failure, stable coronary artery disease, myocardial infarction, and atrial fibrillation was noted, although for some disease entities, it remained relatively high. CONCLUSIONS Between the years 2006 and 2014, in‑hospital and 12‑month mortality showed a trend for decline in many disease entities, with considerable space for prognostic improvement.

Hospital Admission for Respiratory and Cardiovascular Diseases Due to Particulate Matter in Ilam, Iran

Background: Particulate matter with an aerodynamic diameter lower than 10 µm (PM10) has the most undesired adverse effects on human health. Several studies reported a strong correlation between PM levels and hospital admissions owing to chronic and acute respiratory and cardiovascular diseases. Objectives: The current study aimed to estimate the effect of PM10 as a primary pollutant on respiratory and cardiovascular hospitalizations in Ilam, Iran, in 2013. Methods: PM10 data was taken from the Ilam environmental protection agency. The annual morbidity including hospital admission for respiratory and cardiovascular diseases due to PM10 exposure were estimated using relative risk (RR) and baseline incidence (BI) based on world health organization (WHO) databases for AirQ2.2.3 model. Results: The results showed that the maximum level of PM10 was obtained in summer with a concentration of 491 μg/m3. The cumulative number of excess cases admitted to the hospital for respiratory and cardiovascular diseases were 216 and 84, respectively. Approximately 3.95% of the cases hospitalized due to PM10 occurred during days with concentration levels lower than 20 μg/m3. The highest rate of person-days related to PM10 that led to heath effect among Ahvaz inhabitants was in concentration levels of 40 - 49 µg/m3. Conclusions: To reduce the impacts of particulate matter on health status of people in Ilam, necessary training by health systems should be conducted for people, especially those with chronic lung and heart diseases, the elderly and children to reduce their activities on the dusty days.

Effect of different temperatures on hospital admissions for cardiovascular and cerebrovascular diseases: A case study

Although many studies have explored the effect of temperature on cardio-cerebrovascular mortality, little evidence is available for that of morbidity, especially in China. In this study, the effect of mean daily meteorological temperature on daily hospital admissions for cardio-cerebrovascular diseases was evaluated by the distributed lag non-linear model on the basis of three years' data. Particularly, extreme hot and cold temperatures' influence was investigated by treating relative risks at the 1st and 99th percentile temperatures as cold and hot effect of temperature, respectively. Besides, the effect of modification by individual characteristics was also examined. Our results show that there are a J-shaped relationship between temperature and morbidity. Both hot and cold temperatures were associated with increased hospital admissions; however, their variation patterns are different as hot effect is immediate and of short term duration whereas cold effect could be delayed by about five days and would last for more than two weeks.

Distinguishing the associations between daily mortality and hospital admissions and nitrogen dioxide from those of particulate matter: a systematic review and meta-analysis

ObjectivesTo quantitatively assess time-series studies of daily nitrogen dioxide (NO2) and mortality and hospital admissions which also controlled for particulate matter (PM) to determine whether or to what extent the...

Air pollution and risk of respiratory and cardiovascular hospitalizations in the most populous city in Vietnam

Air pollution has become an alarming issue in Vietnam recently; however, there was only one study so far on the effects of ambient air pollution on population health. Our study aimed to investigate the short-term effects of air pollutants including PM10, NO2, SO2, and O3 on respiratory and cardiovascular hospitalizations in Ho Chi Minh City (HCMC), the largest city in Vietnam. Data on hospitalization from the two largest hospitals in HCMC and daily records of PM10, NO2, SO2, O3 and meteorological data were collected from February 2004 to December 2007. A time-series regression analysis with distributed lag model was applied for data analysis. Changes in levels of NO2 and PM10 were strongly associated with hospital admissions for both respiratory and cardiovascular diseases (CVD); whereas levels of SO2 were only moderately associated with respiratory and CVD hospital admissions and O3 concentration was not associated with any of them. For a 10μg/m3 increase of each air pollutant, the risk of respiratory admissions increased from 0.7% to 8% while the risk of CVD admissions increased from 0.5% to 4%. Females were found to be more sensitive than males to exposure to air pollutants in regard to respiratory diseases. In regard to CVD, females (RR, 1.04, 95% CI, 1.01–1.07) had a slightly higher risk of admissions than males (RR, 1.03, 95% CI, 1–1.06) to exposure to NO2. In contrast, males (RR, 1.007, 95%CI, 1–1.01) had a higher risk of admission than females (RR, 1.004, 95%CI, 1.001–1.007) to exposure to PM10. People in the age group of 5–65year-olds had a slightly higher risk of admissions caused by air pollutants than the elderly (65+years old) except for a significant effect of PM10 on the risk of cardiovascular admissions was found for the elderly only.

Investigating the Health Effects of Exposure to Criteria Pollutants Using AirQ2.2.3 in Shiraz, Iran

ABSTRACTThe quality of air is one of the main environmental issues related to human health. The aim of this study was to evaluate the effects of air pollution on the health of residents in Shiraz, as one of the major cities in Southern Iran, with population of 1500000 people. In this study, AirQ2.2.3 model developed by the WHO European Centre for Environment and Health was used. Daily concentration of particulate matter less than 10 microns in diameter (PM10), sulfur dioxide, nitrogen dioxide and maximum 8-hour average ozone concentration were used to evaluate the health effects of human exposure to these pollutants. The total number of excess deaths, Cardiovascular Disease (CVD) mortality, mortality from respiratory diseases, hospital admissions for CVD and hospital admissions for respiratory disease (RD) were calculated. In 2012 and 2013, hospital admissions for respiratory disease for the WHO baseline incidence of PM10 were respectively 54.6% and 38.6% of the total hospital admissions for respiratory disease. That was the highest short-term health effects on 1500000 Shirazi residents. The assessments carried out indicated the possibility that CVD mortality can play a major role in mortality due to PM10, SO2 and O3 pollutants. Overall, the results showed that health effects resulting from exposure to pollutants are directly related to their concentration. Therefore, immediate action to prevent pollution and reduce emissions from various sources, such as transport and energy production industries, is required to reduce the concentration of pollutants in Shiraz.

Assessing the effects of the Spanish partial smoking ban on cardiovascular and respiratory diseases: methodological issues

ObjectiveRecent research has assessed the impact of tobacco laws on cardiovascular and respiratory morbidity. In this study, we also examined whether the association between the implementation of the 2005 Spanish...

HOSPITALIZAÇÕES POR DOENÇAS DO APARELHO CIRCULATÓRIO EM IDOSOS E ESTRATÉGIA SAÚDE DA FAMÍLIA

Introdução: O processo de envelhecimento populacional brasileiro trouxe consigo o aumento de casos diagnosticados de doenças crônicas não transmissíveis na população idosa. Concomitante a esse processo, verifica-se um aumento das hospitalizações, ocasionadas principalmente pelas doenças do aparelho circulatório. Nesse contexto, torna-se de grande valia a atuação de políticas assistenciais que valorizem a Atenção Básica, na perspectiva da melhora da qualidade de vida dos idosos como, por exemplo, a Estratégia Saúde da Família. Objetivo: Avaliar a relação entre a expansão da Estratégia Saúde da Família e as internações por doença cardíaca em idosos, de Montes Claros-MG, nos últimos 13 anos. Material e Métodos: Estudo epidemiológico, do tipo ecológico, com abordagem de série temporal. Os dados foram extraídos a partir do Sistema de Informações Hospitalares e Sistema de Informação da Atenção Básica. A análise estatística foi feita por meio de uma análise descritiva e bivariada, com uso do Teste de Shapiro-Wilk e correlação de Pearson, considerando significativas as associações se P-valor<0,05. Resultados: Observou-se um aumento nos registros de internações hospitalares por doença cardíaca. Contudo, ao ser considerado o aumento populacional entre os anos de 2000-2012, há uma redução de 10,7% em seu coeficiente. Em relação a cobertura da Estratégia Saúde da Família, evidenciou um aumento de 219,6%. Há associação entre a redução no indicador de hospitalizações por doenças do aparelho circulatório e a expansão da Estratégia Saúde da Família (r=-0,636; P-valor=0,019). Conclusão: A Estratégia Saúde da Família parece ter dado uma importante contribuição para a redução das internações por doenças cardíacas em idosos de Montes Claros entre o período de 2000 a 2012.

Short-Term Effects of Coarse Particulate Matter on Hospital Admissions for Cardiovascular Diseases: A Case-Crossover Study in a Tropical City

This study was undertaken to determine whether there was an association between coarse particles (PM2.5-10) levels and frequency of hospital admissions for cardiovascular diseases (CVD) in Kaohsiung, Taiwan. Hospital admissions for CVD, including ischemic heart disease (IHD), stroke, congestive heart failure (CHF), and arrhythmias, and ambient air pollution data levels for Kaohsiung were obtained for the period 2006–2010. The relative risk of hospital admissions for CVD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), increased rates of admissions for CVD were significantly associated with higher coarse PM levels only on cool days (< 25°C), with a 10-μg/m3 elevation in PM2.5-10 concentrations associated with a 3% (95% CI = 2–4%) rise in IHD admissions, 5% (95% CI = 4–6%) increase in stroke admissions, 3% (95% CI = 1–6%) elevation in CHF admissions, and 3% (95% CI = 0–6%) rise in arrhythmias admissions. No significant associations were found between coarse particle levels and number of hospital admissions for CVD on warm days. In the two-pollutant models, PM2.5-10 levels remained significantly correlated with higher rate of CVD admissions even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. Compared to the effect estimate associated with a 10-μg/m3 increase in PM2.5 levels, effect estimates of frequency of CVD-related admissions associated with a 10-μg/m3 rise in coarse PM levels were weaker. This study provides evidence that higher levels of PM2.5-10 enhance the risk of hospital admissions for CVD.

Air pollution and hospital admissions for cardiorespiratory diseases in Iran: artificial neural network versus conditional logistic regression

This study was conducted to evaluate the relationship between air pollutants (including nitrogen oxides [NO, NO2, NOX], sulfur dioxide [SO2], carbon monoxide [CO], ozone [O3], and particulate matter of median aerometric diameter <10 μm [PM10]) and hospital admissions for cardiovascular and respiratory diseases. The study had a case–crossover design which was conducted in Tabriz, Iran. Daily hospital admissions and air quality data from March 2009 to March 2011 were analyzed using the artificial neural networks (ANNs) and conditional logistic regression modeling. The results showed significant associations between gaseous air pollutants including NO2, O3, and NO and hospital admissions for cardiovascular disease. Gaseous air pollutants of NO2, NO, and CO were associated with hospital admissions for chronic obstructive pulmonary disease, while PM10 was associated with hospitalizations due to respiratory infections. PM10 and O3 were also associated with asthmatic hospital admissions. There was no significant association between SO2 and studied health outcomes. Comparing the results of logistic regressions and ANNs confirmed the optimality of the ANNs for detection of the best predictors of hospital admissions caused by air pollution. Further research is required to investigate the effects of seasonal variations on air pollution-related health outcomes.

Left Atrial Volumes and Function: Evaluation With Real-Time 3D Echocardiography in an Acute Care Setting

Background: Limited data are available about feasibility and clinical value of left atrium (LA) quantitative evaluation obtained from real time 3D (RT-3D) echocardiography in critically ills. Objectives: Aims of this study were: 1) to evaluate feasibility of RT-3D echocardiography for LA evaluation in an acute care setting and in a population including a majority of critically ills; 2) to evaluate correlation between two-dimensional (2D) and RT-3D echocardiographic LA quantitative evaluation; 3) to assess clinical consistency and prognostic value of LA measurements obtained from RT-3D images in subjects without CV diseases and in patients with AF and CHF, evaluated in the acute phase of the disease. Patients and Methods: In 382 subjects admitted in the emergency department (ED), we evaluated maximal (Volmax) and minimal (Volmin) LA volumes and LA emptying fraction (LA-EF), from RT-3D images, with a semiautomated border detection program. A follow-up was performed in order to evaluate all-cause mortality and new hospital admission for cardiovascular events. Results: The correlation between measures obtained from 2D and 3D was good (LA Volmax: r = 0.896, P < 0.001; Volmin: r = 0.906, P < 0,001; LA EF: r = 0.749, P < 0.001). Among 77 normal subjects, people aged ≥ 65 years demonstrated comparable LA dimensions with younger subjects (LA Volmax: 25 ± 11 vs 20 ± 7 mL/m 2 , Volmin: 11 ± 7 vs 8 ± 5 mL/m 2 ). Subjects with normal left ventricular ejection fraction showed LA Volmax significantly lower than patients with LV systolic dysfunction or congestive heart failure (23 ± 11 vs 29 ± 10 vs 33 ± 12 mL/m 2 , P < 0.05). Patients in atrial fibrillation showed a significantly dilated LA compared with subjects in sinus rhytm (24 ± 11 vs 37 ± 22 mL/m 2 , P < 0.05). LA dimensions were significantly higher in non-survivors (LA Volmax: 33 ± 9 vs 25 ± 9 mL/m 2 ), in patients with a new hospital admission for cardiovascular disease (LA Volmax: 34 ± 13 vs 23 ± 10 mL/m 2 ) or with a new AF episode (LA Volmax: 40 ± 12 vs 24 ± 11 mL/m 2 , all P < 0.005). Conclusions: RT-3D evaluation of LA volumes and function is feasible in a non selected series of critically ills. LA dilation was associated with a worse outcome in terms of morbidity and mortality.

The Effects Of Air Pollution On Acute Myocardial Infarction, By Gender

Introduction: Cardiovascular diseases, especially acute myocardial infarction, are the main cause of mortality and disability in Brazil and in the world. Several studies have shown evidence about the effects of air pollution on these diseases and their impact on health system. Objective: To assess the lag structure between air pollution exposure and over 50 year old cardiovascular diseases hospital admissions, by gender. The study period was January 1, 2012 to December 31, 2013, in São José dos Campos SP. Methods: This is a time series ecological study. The daily data of hospitalizations due to AMI (by gender), pollutants CO, O3, PM10, SO2 and NO2 were analyzed to estimate the association between hospitalizations due to AMI and air pollutants. It was fitted generalized linear Poisson regressions to assess the relative risk with lagged effects of air pollutants on hospital admissions up to 5 days after exposure, adjusted for time trend, minimum temperature, relative humidity and weekdays. Results: 1837 individuals were hospitalized in the period by AMI, with 636 women and 1201 men. For women, the risks were significant for CO in Lags 0 (RR = 1.31), Lag1 (RR = 1.28) and Lag 5 (RR = 1.44) and for SO2 in Lag 0 (RR = 1.05). For men there was significance for CO on Lag 5 (RR = 1.24). Regardless of gender was significant for CO on Lag 5 (RR = 1.30) and Lag 0 for SO2 (RR = 1.01). Discussion: There are few national studies that show the effects of CO exposure and hospitalizations for AMI. Our study demonstrates that the effects of CO exposure were higher and early among female group. SO2 was significant when both genders were analyzed, however when SO2 was categorized, remained significant only in the female gender. The data presented shows the important role of CO and SO2 in the genesis of admissions and it's suggested that studies about effects of air pollution should be categorized according to gender, because the risks changes according to gender, pollutant and lag.

Effect of Uruguay's National 100% Smokefree Law on Emergency Visits for Bronchospasm.

Implementation of smokefree laws is followed by drops in hospital admissions for cardiovascular diseases and asthma. The impact of smokefree laws on use of non-hospital medical services has not been assessed. The purpose of this study is to evaluate the impact of Uruguay's national 100% smokefree legislation on non-hospital emergency care visits, hospitalizations for bronchospasm, and bronchodilator use. The monthly number of non-hospital emergency care visits and hospitalizations for bronchospasm, as well as monthly puffs of bronchodilators (total and per person), from 3 years prior to the adoption of the 100% smokefree policy on March 1, 2006, through 5 years after the policy were assessed using interrupted time series negative binomial regression. Data analysis was conducted in 2014. The incidence of non-hospital emergency visits for bronchospasm decreased by 15% (incidence rate ratio [IRR]=0.85, 95% CI=0.76, 0.94) following implementation of the law. Hospitalizations for bronchospasm did not change significantly (IRR=0.89, 95% CI=0.66, 1.21). Total monthly puffs of salbutamol and ipratropium administered in the non-hospital emergency setting decreased by 224 (95% CI=-372, -76) and 179 (95% CI=-340, -18.6), respectively, from means of 1,222 and 1,007 before the law. Uruguay's 100% smokefree law was followed by fewer emergency visits for bronchospasm and less need for treatment, supporting adoption of such policies in low- and middle-income countries to reduce the disease burden and healthcare costs associated with smoking.

Short-term relationships between emergency hospital admissions for respiratory and cardiovascular diseases and fine particulate air pollution in Beirut, Lebanon

High levels of major outdoor air pollutants have been documented in Lebanon, but their health effects remain unknown. The Beirut Air Pollution and Health Effects study aimed to determine the relationship between short-term variations in ambient concentrations of particulate matter (PM10 and PM2.5) and emergency hospital admissions in the city of Beirut, and whether susceptible groups are more greatly affected. An autoregressive Poisson model was used to evaluate the association between daily concentrations of particulate matter and respiratory and cardiovascular emergency hospital admissions after controlling for confounders. All variables were measured during 1 year from January 2012 to December 2012. Relative risks of admissions for respiratory and cardiovascular diseases were calculated for an increase in 10 μg.m(-3) of pollutant concentrations. Total respiratory admissions were significantly associated with the levels of PM10 (1.012 [95% CI 1.004-1.02]) per 10 μg.m(-3) rise in daily mean pollutant concentration for PM10 and 1.016 [95% CI 1.000-1.032] for PM2.5 on the same day. With regard to susceptible groups, total respiratory admissions were associated with PM2.5 and PM10 within the same day in children (relative risk (RR), 1.013 and 1.014; 95% confidence interval, 0.985-1.042 and 1.000-1.029 for PM2.5 and PM10, respectively). Moreover, a nearly significant association was found between particles and total circulatory admissions for adults and elderly groups in the same day. These results are similar to other international studies. Therefore, air pollution control is expected to reduce the number of admissions of these diseases in Lebanon.

Cardiovascular disease in Adult Life after Childhood Cancer in Scandinavia: A population-based cohort study of 32,308 one-year survivors.

The lifetime risk for cardiovascular disease in a large cohort of childhood cancer survivors has not been fully assessed. In a retrospective population-based cohort study predicated on comprehensive national health registers, we identified a cohort of 32,308 one-year survivors of cancer diagnosed before the age of 20 in the five Nordic countries between the start of cancer registration in the 1940s and 1950s to 2008; 211,489 population comparison subjects were selected from national population registers. Study subjects were linked to national hospital registers, and the observed numbers of first hospital admission for cardiovascular disease among survivors were compared with the expected numbers derived from the population comparison cohort. Cardiovascular disease was diagnosed in 2,632 childhood cancer survivors (8.1%), yielding a standardized hospitalization rate ratio (RR) of 2.1 (95% CI 2.0-2.2) and an overall absolute excess risk (AER) of 324 per 100,000 person-years. At the end of follow-up 12% of the survivors were ≥ 50 years of age and 4.5% ≥ 60 years of age. Risk estimates were significantly increased throughout life, with an AER of ∼500-600 per 100,000 person-years at age ≥ 40. The highest relative risks were seen for heart failure (RR, 5.2; 95% CI 4.5-5.9), valvular dysfunction (4.6; 3.8-5.5) and cerebrovascular diseases (3.7; 3.4-4.1). Survivors of hepatic tumor, Hodgkin lymphoma and leukemia had the highest overall risks for cardiovascular disease, although each main type of childhood cancer had increased risk with different risk profiles. Nordic childhood cancer survivors are at markedly increased risk for cardiovascular disorders throughout life. These findings indicate the need for preventive interventions and continuous follow-up for this rapidly growing population.

Short-Term Effects of Fine Particulate Air Pollution on Hospital Admissions for Cardiovascular Diseases: A Case-Crossover Study in a Tropical City

This study was undertaken to determine whether there was an association between fine particles (PM2.5) levels and hospital admissions for cardiovascular diseases (CVD) in Kaohsiung, Taiwan. Hospital admissions for CVD (including ischemic heart disease [IHD], stroke, congestive heart failure [CHF], and arrhythmias) and ambient air pollution data for Kaohsiung were obtained for the period from 2006–2010. The relative risk of hospital admissions for CVD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), elevated number of admissions for CVD were significantly associated with higher PM2.5 levels only on cool days (<25°C), with an interquartile range rise associated with a 47% (95% CI = 39–56%), 48% (95% CI = 40–56%), 47% (95% CI = 34–61%), and 51% (95% CI = 34–70%) increase in IHD, stroke, CHF, and arrhythmias admissions, respectively. No significant associations between PM2.5 and hospital admissions for CVD were observed on warm days. In the two-pollutant models, PM2.5 levels remained significant even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. This study provides evidence that higher levels of PM2.5 enhance the risk of hospital admissions for CVD in Kaohsiung, Taiwan.

Toxic urban waste's assault on cardiovascular risk

A cardiovascular health survey of 1203 persons in households located near the hazardous waste disposal sites and in a reference community, was conducted from 2009 until today to assess whether rates of adverse cardiovascular health outcomes were elevated among persons living near the sites. Data included medical records of reported cardiovascular disease certificates and hospital admission for cardiovascular diseases from hospital database. The study areas appeared similar with respect to mortality, cancer incidence, and pregnancy outcomes. In contrast, rate ratios were greater than 1.5 for 2 of 19 reported diseases, i.e., angina pectoris, and strokes. The apparent broad-based elevation in reported diseases and symptoms may reflect increased perception or recall of conditions by respondents living near the sites. Our study found that cardiovascular risk is associated only with PM2.5 concentrations, derived from uncontrolled burning of municipal solid waste in particular sites of our country. Their analysis demonstrated a relationship between increased levels of eventual fine particulate pollution and higher rates of death and complications from cardiovascular and cerebrovascular diseases. Management of solid waste releases a number of toxic substances, most in small quantities and at extremely low levels. Because of the wide range of pollutants, the different pathways of exposure, long-term low-level exposure, and the potential for synergism among the pollutants, concerns remain about potential health effects but there are many uncertainties involved in the assessment. Future community-based health studies should include medical and psychosocial assessment instruments sufficient to distinguish between changes in health status and effects of resident reporting tendency.

IMPACT OF THE AMBIENT AIR PM2.5 ON CARDIOVASCULAR DISEASES OF ULAANBAATAR RESIDENTS

Mongolia is a landlocked country with a total land area of 1,564,116 square kilometers. The ambient annual average particulate matter (PM) concentration in Ulaanbaatar is 10–25 times greater than the Mongolian air quality standards (AQS). More than 40 percent of the nation’s total population lives in Ulaanbaatar. The study aims at defining the relationship between the ambient air PM2.5 level and hospital admissions in Ulaanbaatar in 2011–2014. The pollution data included a 24-hour average PM2.5. The air was sampled daily and recorded by the national air monitoring stations located in Ulaanbaatar. The sampling frame of hospital admissions for cardiovascular disease (CVD) were the records of all outpatient hospitals of Ulaanbaatar. The data covered the period from January 2011 to January 2014. To test the differences of the results, appropriate statistical tests were employed. During 2011–2014, the highest concentration of PM2.5 was in the coldest period and the particulate matter level recorded was 3.7 times higher in the cold period than the warm period. The number of admissions for CVD were the highest during cold periods. Four days after exposure, the PM2.5 impact on hospital admissions weakened but there remained a positive correlation. For PM2.5, 100 μg/m3 growth of the pollutant led to 0.65 % increase in the hospitalization for CVD on the exposure day. On the second day of exposure, 10 μg/m3 growth of the pollutant led to 0.66 % increase; on the third day of exposure, 10 μg/m3 growth of the pollutant led to 0.08 % increase of hospital admissions for CVD, and at the fourth day, such growth led to 0.6 % increase of CVD cases in 2011–2014 in Ulaanbaatar. In conclusion we may state that most incidences of CVD registered during the cold months in Ulaanbaatar in the last four years were a result of PM2.5 exposure. This shows that the PM2.5 exposure and hospital admissions for cardiovascular system chronic diseases are positively correlated. CVD in Ulaanbaatar residents was affected greater on the same and the third day of exposure.

Cardiovascular disease-related hospital admissions of patients with inflammatory arthritis.

Patients with inflammatory arthritis (IA) have an increased risk of cardiovascular diseases (CVD), suggesting a high rate of CVD-related hospitalizations, but data on this topic are limited. Our study addressed hospital admissions for CVD in a primary care-based population of patients with IA and controls. All newly diagnosed patients with IA between 2001 and 2010 were selected from electronic medical records of the Netherlands Institute for Health Services Research Primary Care database, representing a national network of general practices. Two control patients matched for age, sex, and practice were selected for each patient with IA. Hospital admission data for all patients was retrieved from the Dutch Hospital Data. There were 2615 patients with IA and 5555 controls included in our study. CVD-related hospital admissions were observed more frequently among patients with IA as compared with control patients: 48% versus 36% (p < 0.001) in a followup period of 4 years. Patients with IA were more often hospitalized because of ischemic heart disease (OR 1.7, 95% CI 1.2-2.2) and for day-care admission because of cerebrovascular disease (OR 2.2, 95% CI 1.0-4.9). Increased hospital admission rates confirm the higher CVD burden among patients with IA compared with controls, and underscore the need for proper CVD risk management in patients with IA.

The effect of temperature on cardiovascular disease hospital admissions among elderly people in Thai Nguyen Province, Vietnam

Background Projected increases in weather variability due to climate change will have severe consequences on human health, increasing mortality, and disease rates. Among these, cardiovascular diseases (CVD), highly prevalent among the elderly, have been shown to be sensitive to extreme temperatures and heat waves. Objectives This study aimed to find out the relationship between daily temperature (and other weather parameters) and daily CVD hospital admissions among the elderly population in Thai Nguyen province, a northern province of Vietnam. Methods Retrospective data of CVD cases were obtained from a data base of four hospitals in Thai Nguyen province for a period of 5 years from 2008 to 2012. CVD hospital admissions were aggregated by day and merged with daily weather data from this period. Distributed lag non-linear model (DLNM) was used to derive specific estimates of the effect of weather parameters on CVD hospital admissions of up to 30 days, adjusted for time trends using b-splines, day of the week, and public holidays. Results This study shows that the average point of minimum CVD admissions was at 26°C. Above and below this threshold, the cumulative CVD admission risk over 30 lag days tended to increase with both lower and higher temperatures. The cold effect was found to occur 4–15 days following exposure, peaking at a week's delay. The cumulative effect of cold exposure on CVD admissions was statistically significant with a relative risk of 1.12 (95% confidence interval: 1.01–1.25) for 1°C decrease below the threshold. The cumulative effect of hot temperature on CVD admissions was found to be non-significant and was estimated to be at a relative risk of 1.17 (95% confidence interval: 0.90–1.52) for 1°C increase in the temperature. No significant association was found between CVD admissions and the other weather variables. Conclusion Exposure to cold temperature is associated with increasing CVD admission risk among the elderly population.