Abstract
Background
Summer heat waves with temperature extremes are becoming more frequent with growing numbers in morbidity and mortality in patients with respiratory diseases. The aim of this study was to evaluate the ramifications of heat stress (temperature >25 °C) on the health status of patients with pulmonary arterial hypertension (PAH).
Methods
Fifteen patients with PAH (mean age = 66.7 ± 5.2 years) continuously wore an accelerometer from April 1 to September 30, 2011, and their daily step count was recorded. In addition, patients kept a diary to record data on seven standardized questions regarding their daily symptoms. Echocardiography, 6-minute walk test, NTproBNP, and Modified Medical Research Council Scale (MMRC) were assessed at baseline and at the end of the study after 6 months.
Results
On heat-stress days, patients showed significantly more symptoms and lower total steps/day compared to thermal comfort days (3,995 ± 2,013 steps/day vs. 5,567 ± 2,434 steps/day, respectively; P < 0.001). There was a significant negative correlation between total steps/day and Tempmax (R = −0.47; P < 0.001) and humidity (R = −0.34; P < 0.001). A significant positive correlation was found between daily symptoms and Tempmax (R = +0.79; P < 0.001) and humidity (R = +0.23; P < 0.001).
Conclusions
Heat stress is associated with a compromised clinical status in patients with PAH. Adaptation strategies must be implemented to prevent heart-related morbidity, including therapeutic adjustments and adequate room cooling in the patient’s home and at the hospital.
Similar content being viewed by others
References
Lin S, Hsu WH, Van Zutphen AR, Saha S, Luber G, Hwang SA (2012) Excessive heat and respiratory hospitalizations in New York State: estimating current and future public health burden related to climate change. Environ Health Perspect 120:1571–1577
Meehl GA, Tebaldi C (2004) More intense, more frequent, and longer lasting heat waves in the 21st century. Science 305:994–997
Badesch DB, Champion HC, Sanchez MA, Hoeper MM, Loyd JE, Manes A, McGoon M, Naeije R, Olschewski H, Oudiz RJ, Torbicki A (2009) Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol 54:S55–S66
Bouchama A, Dehbi M, Mohamed G, Matthies F, Shoukri M, Menne B (2007) Prognostic factors in heat wave related deaths: a meta-analysis. Arch Intern Med 167:2170–2176
Semenza JC, Rubin CH, Falter KH, Selanikio JD, Flanders WD, Howe HL, Wilhelm JL (1996) Heat-related deaths during the July 1995 heat wave in Chicago. N Engl J Med 335:84–90
Stafoggia M, Forastiere F, Agostini D, Caranci N, de’Donato F, Demaria M, Michelozzi P, Miglio R, Rognoni M, Russo A, Perucci CA (2008) Factors affecting in-hospital heat-related mortality: a multi-city case-crossover analysis. J Epidemiol Community Health 62:209–215
Zanobetti A, O’Neill MS, Gronlund CJ, Schwartz JD (2012) Summer temperature variability and long-term survival among elderly people with chronic disease. Proc Natl Acad Sci U S A 109:6608–6613
Miyamoto S, Nagaya N, Satoh T, Kyotani S, Sakamaki F, Fujita M, Nakanishi N, Miyatake K (2000) Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension: comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med 161:487–492
Pugh ME, Buchowski MS, Robbins IM, Newman JH, Hemnes AR (2012) Physical activity limitation as measured by accelerometry in pulmonary arterial hypertension. Chest 142:1391–1398
Mainguy V, Provencher S, Maltais F, Malenfant S, Saey D (2011) Assessment of daily life physical activities in pulmonary arterial hypertension. PLoS One 6:e27993
Simonneau G, Robbins IM, Beghetti M, Channick RN, Delcroix M, Denton CP, Elliott CG, Gaine SP, Gladwin MT, Jing ZC, Krowka MJ, Langleben D, Nakanishi N, Souza R (2009) Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 54:S43–S54
Chemla D, Castelain V, Herve P, Lecarpentier Y, Brimioulle S (2002) Haemodynamic evaluation of pulmonary hypertension. Eur Respir J 20:1314–1331
Jehn M, Schmidt-Trucksäss A, Schuster T, Hanssen H, Weis M, Halle M, Koehler F (2009) Accelerometer-based quantification of 6-minute walk test performance in patients with chronic heart failure: applicability in telemedicine. J Card Fail 15:334–340
Jehn M, Schmidt-Trucksäss A, Schuster T, Weis M, Hanssen H, Halle M, Koehler F (2009) Daily walking performance as an independent predictor of advanced heart failure: prediction of exercise capacity in chronic heart failure. Am Heart J 157:292–298
Anker SD, Koehler F, Abraham WT (2011) Telemedicine and remote management of patients with heart failure. Lancet 378:731–739
Koehler F, Winkler S, Schieber M, Sechtem U, Stangl K, Bohm M, Boll H, Kim SS, Koehler K, Lucke S, Honold M, Heinze P, Schweizer T, Braecklein M, Kirwan BA, Gelbrich G, Anker SD (2010) Telemedical interventional monitoring in heart failure (TIM-HF), a randomized, controlled intervention trial investigating the impact of telemedicine on mortality in ambulatory patients with heart failure: study design. Eur J Heart Fail 12:1354–1362
Koehler F, Winkler S, Schieber M, Sechtem U, Stangl K, Bohm M, Boll H, Baumann G, Honold M, Koehler K, Gelbrich G, Kirwan BA, Anker SD (2011) Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study. Circulation 123:1873–1880
Curriero FC, Heiner KS, Samet JM, Zeger SL, Strug L, Patz JA (2002) Temperature and mortality in 11 cities of the eastern United States. Am J Epidemiol 155:80–87
D’Ippoliti D, Michelozzi P, Marino C, de’Donato F, Menne B, Katsouyanni K, Kirchmayer U, Analitis A, Medina-Ramon M, Paldy A, Atkinson R, Kovats S, Bisanti L, Schneider A, Lefranc A, Iniguez C, Perucci CA (2010) The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project. Environ Health 9:37
Michelozzi P, Accetta G, De SM, D’Ippoliti D, Marino C, Baccini M, Biggeri A, Anderson HR, Katsouyanni K, Ballester F, Bisanti L, Cadum E, Forsberg B, Forastiere F, Goodman PG, Hojs A, Kirchmayer U, Medina S, Paldy A, Schindler C, Sunyer J, Perucci CA (2009) High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities. Am J Respir Crit Care Med 179:383–389
O’Neill MS, Zanobetti A, Schwartz J (2003) Modifiers of the temperature and mortality association in seven US cities. Am J Epidemiol 157:1074–1082
Mereles D, Ehlken N, Kreuscher S, Ghofrani S, Hoeper MM, Halank M, Meyer FJ, Karger G, Buss J, Juenger J, Holzapfel N, Opitz C, Winkler J, Herth FF, Wilkens H, Katus HA, Olschewski H, Grunig E (2006) Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation 114:1482–1489
Tudor-Locke C, Bassett DR Jr (2004) How many steps/day are enough? preliminary pedometer indices for public health. Sports Med 34:1–8
CCF Report (2006) The Center for health and the global environment. Harvard Medical School, Boston
Acknowledgments
This study was funded by the German Ministry for Education and Research (BMBF: NCT01LR0803L) and Deutsche Forschungsgemeinschaft (DFG), Research Unit 1736 Urban Climate Change and Heat Stress in mid-latitude cities in view of climate change (UCaHS) WI-1516/2-1.
Conflict of interest
The authors declare that they have no conflicts of interest in relation to this article.
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Jehn, M., Gebhardt, A., Liebers, U. et al. Heat Stress is Associated with Reduced Health Status in Pulmonary Arterial Hypertension: A Prospective Study Cohort. Lung 192, 619–624 (2014). https://doi.org/10.1007/s00408-014-9587-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00408-014-9587-4