Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Physiological and perceived health effects from daily changes in air pollution and weather among persons with heart failure: A panel study

Journal of Exposure Science & Environmental Epidemiology volume 25, pages 187–199 (2015)Cite this article

Subjects

Abstract

We carried out this daily diary panel study in Montreal, Quebec, to determine whether oxygen saturation, pulse rate, blood pressure, self-rated health, and shortness of breath at night were associated with concentrations of indoor carbon monoxide (CO), and indoor and outdoor fine particles (PM2.5), temperature, and relative humidity. Over a 2-month consecutive period between 2008 and 2010, we measured daily indoor and outdoor levels of the air pollutants and weather variables and 55 subjects measured their daily health and other variables. To estimate the associations between the health outcomes and the environmental exposures, we used a mixed effects regression model using an autoregressive model of order-one and we adjusted for month and day and personal variables. The general pattern of associations can be summarized as follows: oxygen saturation was reduced for increases in indoor- and outdoor-PM2.5 and temperature. Pulse rate increased on the concurrent day for increases in indoor CO and PM2.5. Diastolic blood pressure increased with increasing indoor and outdoor PM2.5 and relative humidity. Systolic blood pressure increased with indoor PM2.5 and decreased with increasing indoor and outdoor temperature. Self-rated health diminished with increases in outdoor PM2.5 and indoor and outdoor temperature. Self-reported shortness of breath at night increased with increasing indoor and outdoor temperatures. Health in heart failure is affected in the short term by personal and environmental conditions that are manifest in intermediate physiological parameters.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6

Similar content being viewed by others

Abbreviations

CI:

confidence interval

CO:

carbon monoxide

IQR:

interquartile range

PM2.5:

particles having an aerodynamic diameter of 2.5 μm or less

References

  1. Goldberg MS, Burnett R, Valois MF, Flegel KM, Bailar JC, III, Brook J et al. Associations between ambient air pollution and daily mortality among persons with congestive heart failure. Environ Res 2003; 91: 8–20.

    Article  CAS  Google Scholar 

  2. Koken PJ, Piver WT, Ye F, Elixhauser A, Olsen LM, Portier CJ . Temperature air pollution, and hospitalization for cardiovascular diseases among elderly people in Denver. Environ Health Perspect 2003; 111: 1312–1317.

    Article  Google Scholar 

  3. Lee IM, Tsai S-S, Ho C-K, Chiu H-F, Yang CY . Air pollution and hospital admissions for congestive heart failure in a tropical city: Kaohsiung, Taiwan. Inhal Toxicol 2007; 19: 899–904.

    Article  CAS  Google Scholar 

  4. Symons JM, Wang L, Guallar E, Howell E, Dominici F, Schwab M et al. A case-crossover study of fine particulate matter air pollution and onset of congestive heart failure symptom exacerbation leading to hospitalization. Am J Epidemiol 2006; 164: 421–433.

    Article  CAS  Google Scholar 

  5. Wellenius GA, Schwartz J, Mittleman MA . Particulate air pollution and hospital admissions for congestive heart failure in seven United States cities. Am J Cardiol 2006; 97: 404–408.

    Article  CAS  Google Scholar 

  6. Wellenius GA, Bateson TF, Mittleman MA, Schwartz J . Particulate air pollution and the rate of hospitalization for congestive heart failure among medicare beneficiaries in Pittsburgh, Pennsylvania. Am J Epidemiol 2005; 161: 1030–1036.

    Article  Google Scholar 

  7. Goldberg MS, Burnett RT, Stieb DM, Brophy JM, Daskalopoulou SS, Valois MF et al. Associations between ambient air pollution and daily mortality among elderly persons in Montreal, Quebec. Sci Total Environ 2013; 463-464: 931–942.

    Article  CAS  Google Scholar 

  8. Forastiere F, Stafoggia M, Tasco C, Picciotto S, Agabiti N, Cesaroni G et al. Socioeconomic status, particulate air pollution, and daily mortality: differential exposure or differential susceptibility. Am J Ind Med 2007; 50: 208–216.

    Article  Google Scholar 

  9. Lee IM, Tsai SS, Chang CC, Ho CK, Yang CY . Air pollution and hospital admissions for chronic obstructive pulmonary disease in a tropical city: Kaohsiung, Taiwan. InhalToxicol 2007; 19: 393–398.

    CAS  Google Scholar 

  10. Peel JL, Metzger KB, Klein M, Flanders WD, Mulholland JA, Tolbert PE . Ambient air pollution and cardiovascular emergency department visits in potentially sensitive groups. Am J Epidemiol 2007; 165: 625–633.

    Article  Google Scholar 

  11. Pope CA, 3rd, Renlund DG, Kfoury AG, May HT, Horne BD . Relation of heart failure hospitalization to exposure to fine particulate air pollution. Am J Cardiol 2008; 102: 1230–1234.

    Article  Google Scholar 

  12. Yang C-Y . Air pollution and hospital admissions for congestive heart failure in a subtropical city: Taipei, Taiwan. J Toxicol Environ Health Pt A 2008; 71: 1085–1090.

    Article  CAS  Google Scholar 

  13. Haley VB, Talbot TO, Felton HD . Surveillance of the short-term impact of fine particle air pollution on cardiovascular disease hospitalizations in New York State. Environ Health: A Global Access Science Source 2009; 8: 42.

    Article  Google Scholar 

  14. Stieb DM, Szyszkowicz M, Rowe BH, Leech JA . Air pollution and emergency department visits for cardiac and respiratory conditions: a multi-city time-series analysis. Environmental Health: A Global Access Science Source 2009; 8: 25.

    Article  Google Scholar 

  15. Ueda K, Nitta H, Ono M . Effects of fine particulate matter on daily mortality for specific heart diseases in Japan.[Erratum appears in Circ J. 2009 oCT;73 (10):1972]. Circ J 2009; 73: 1248–1254.

    Article  CAS  Google Scholar 

  16. Zanobetti A, Franklin M, Koutrakis P, Schwartz J . Fine particulate air pollution and its components in association with cause-specific emergency admissions. Environ Health: A Global Access Science Source 2009; 8: 58.

    Article  Google Scholar 

  17. Rappold AG, Stone SL, Cascio WE, Neas LM, Kilaru VJ, Carraway MS et al. Peat bog wildfire smoke exposure in rural North Carolina is associated with cardiopulmonary emergency department visits assessed through syndromic surveillance. Environ Health Perspect 2011; 119: 1415–1420.

    Article  Google Scholar 

  18. Colais P, Faustini A, Stafoggia M, Berti G, Bisanti L, Cadum E et al. Particulate air pollution and hospital admissions for cardiac diseases in potentially sensitive subgroups. Epidemiology 2012; 23: 473–481.

    Article  Google Scholar 

  19. Hsieh YL, Tsai SS, Yang CY . Fine particulate air pollution and hospital admissions for congestive heart failure: a case-crossover study in Taipei. Inhalation Toxicol 2013; 25: 455–460.

    Article  CAS  Google Scholar 

  20. Atkinson RW, Carey IM, Kent AJ, van Staa TP, Anderson HR, Cook DG . Long-term exposure to outdoor air pollution and incidence of cardiovascular diseases. [Erratum appears in Epidemiology. 2013; 24(2): 339]. Epidemiology 2013; 24: 44–53.

    Article  Google Scholar 

  21. Ebi KL, Exuzides KA, Lau E, Kelsh M, Barnston A . Weather changes associated with hospitalizations for cardiovascular diseases and stroke in California, 1983-1998. Int J Biometeorol 2004; 49: 48–58.

    Article  CAS  Google Scholar 

  22. Morris RD, Naumova EN . Carbon monoxide and hospital admissions for congestive heart failure: evidence of an increased effect at low temperatures. Environ Health Perspect 1998; 106: 649–653.

    Article  CAS  Google Scholar 

  23. Kolb S, Radon K, Valois M-F, Heguy L, Goldberg MS . The short-term influence of weather on daily mortality in congestive heart failure. Arch Environ Occup Health 2007; 62: 169–176.

    Article  Google Scholar 

  24. Schwartz J . Who is sensitive to extremes of temperature?: a case-only analysis. Epidemiology 2005; 16: 67–72.

    Article  Google Scholar 

  25. Basu R . High ambient temperature and mortality: a review of epidemiologic studies from 2001–2008. Environ Health: A Global Access Science Source 2009; 8: 40.

    Article  Google Scholar 

  26. Goldberg MS, Giannetti N, Burnett RT, Mayo NE, Valois MF, Brophy JT . A panel study in congestive heart failure to estimate the short-term effects from personal factors and environmental conditions on oxygen saturation and pulse rate. Occup Environ Med 2008; 65: 659–666.

    Article  CAS  Google Scholar 

  27. Goldberg MS, Giannetti N, Burnett RT, Mayo NE, Valois MF, Brophy JM . Shortness of breath at night and health status in congestive heart failure: effects of environmental conditions and health-related and dietary factors. Environ Res 2009; 109: 166–174.

    Article  CAS  Google Scholar 

  28. Barclay JL, Miller BG, Dick S, Dennekamp M, Ford I, Hillis GS et al. A panel study of air pollution in subjects with heart failure: negative results in treated patients. Occup Environ Med 2009; 66: 325–334.

    Article  CAS  Google Scholar 

  29. Wellenius GA, Yeh GY, Coull BA, Suh HH, Phillips RS, Mittleman MA . Effects of ambient air pollution on functional status in patients with chronic congestive heart failure: a repeated-measures study. Environ Health 2007; 6: 26.

    Article  Google Scholar 

  30. The Criteria Committee for the New York Heart Association Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels Little Brown and Company: New York 1994.

  31. Ferris BG . The epidemiology standardization project (American Thoracic Society). Am Rev of Resp Dis 1978; 118: 1–120.

    CAS  Google Scholar 

  32. Osterman JW, Armstrong BG, Ledoux E, Sloan M, Ernst P . Comparison of French and English versions of the American Thoracic Society Respiratory Questionnaire in a bilingual working population. Int J Epidemiol 1991; 20: 138–143.

    Article  CAS  Google Scholar 

  33. Osterman JW, Brochu D, Theriault G, Greaves IA. Preliminary evaluation of a standard translation of the ATS respiratory disease questionnaire for use in French Canada 1996.

  34. Johns MW . A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 1991; 14: 540–545.

    Article  CAS  Google Scholar 

  35. Ware JE, Sherbourne CD . The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care 1992; 30: 473–483.

    Article  Google Scholar 

  36. Kind P, Spilker B. . The EuroQol instrument: an index of health-related quality of life. In:. Quality of Life and Pharmacoeconomics in Clinical Trials, Vol. Second Lippincott-Raven Publishers: Philadelphia. 1995 pp 191–201.

    Google Scholar 

  37. Rector TS, Kubo SH, Cohn JN . Patients self-assessment of their congestive heart failure: part 2. Content, reliability and validity of a new measure, the Minnesota Living with Heart Failure Questionnaire. Heart Failure 1987; 3: 198–209.

    Google Scholar 

  38. Dockery DW, Pope CA, III, Kanner RE, Villegas GM, Schwartz J . Daily changes in oxygen saturation and pulse rate associated with particulate air pollution and barometric pressure. Res Rep Health Eff Inst 1999;, 1–19.

  39. Pope CA, Dockery DW, Kanner RE, Villegas GM, Schwartz J . Oxygen saturation, pulse rate, and particulate air pollution: a daily time-series panel study [see comments]. Am J Respir Crit Care Med 1999; 159: 365–372.

    Article  Google Scholar 

  40. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A et al. Standardisation of spirometry. Eur Respir J 2005; 26: 319–338.

    Article  CAS  Google Scholar 

  41. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS Statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166: 111–117.

    Article  Google Scholar 

  42. Heroux ME, Clark N, Van Ryswyk K, Mallick R, Gilbert NL, Harrison I et al. Predictors of indoor air concentrations in smoking and non-smoking residences. Int J Environ Res Public Health 2010; 7: 3080–3099.

    Article  CAS  Google Scholar 

  43. Wheeler AJ, Xu X, Kulka R, You H, Wallace L, Mallach G et al. Windsor, Ontario exposure assessment study: design and methods validation of personal, indoor, and outdoor air pollution monitoring. J Air Waste Manag Assoc 2011; 61: 142–156.

    Article  CAS  Google Scholar 

  44. Feenstra J, Grobbee DE, Jonkman FA, Hoes AW, Stricker BH . Prevention of relapse in patients with congestive heart failure: the role of precipitating factors. Heart 1998; 80: 432–436.

    Article  CAS  Google Scholar 

  45. Michalsen A, Konig G, Thimme W . Preventable causative factors leading to hospital admission with decompensated heart failure. Heart 1998; 80: 437–441.

    Article  CAS  Google Scholar 

  46. Schiff GD, Fung S, Speroff T, McNutt RA . Decompensated heart failure: symptoms, patterns of onset, and contributing factors. Am J Med 2003; 114: 625–630.

    Article  Google Scholar 

  47. Tsuyuki RT, McKelvie RS, Arnold JM, Avezum A, Jr., Barretto AC, Carvalho AC et al. Acute precipitants of congestive heart failure exacerbations. Arch Intern Med 2001; 161: 2337–2342.

    Article  CAS  Google Scholar 

  48. Pinehiro JC, Bates DM. . Mixed-Effects Models in S and S-PLUS. Springer Verlag: New York, NY. 2000.

    Book  Google Scholar 

  49. Wallace LA, Wheeler AJ, Kearney J, Van Ryswyk K, You H, Kulka RH et al. Validation of continuous particle monitors for personal, indoor, and outdoor exposures. J Expo Sci Environ Epidemiol 2011; 21: 49–64.

    Article  CAS  Google Scholar 

  50. Balashov K, Feldman DE, Savard S, Houde S, Frenette M, Ducharme A et al. Percent predicted value for the 6-minute walk test: using norm-referenced equations to characterize severity in persons with CHF. J Card Fail 2008; 14: 75–81.

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported financially through a contract with Health Canada.

Author information

Authors and Affiliations

  1. Department of Medicine, McGill University, Montreal, Quebec, Canada

    Mark S Goldberg, Nancy E Mayo, Marie-France Valois, James M Brophy & Nadia Giannetti

  2. Division of Clinical Epidemiology, Department of Medicine, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada

    Mark S Goldberg, Nancy E Mayo, Marie-France Valois & James M Brophy

  3. Centre for Ecosystem Management, School of Natural Sciences, Edith Cowan University, Perth, Western Australia, Australia

    Amanda J Wheeler

  4. Air Health Science Division, Health Canada, Ottawa, Ontario, Canada

    Amanda J Wheeler

  5. Biostatistics and Epidemiology Division, Safe Environments Directorate, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada

    Richard T Burnett

Authors
  1. Mark S Goldberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amanda J Wheeler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard T Burnett
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nancy E Mayo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marie-France Valois
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James M Brophy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nadia Giannetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark S Goldberg.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on the Journal of Exposure Science and Environmental Epidemiology website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goldberg, M., Wheeler, A., Burnett, R. et al. Physiological and perceived health effects from daily changes in air pollution and weather among persons with heart failure: A panel study. J Expo Sci Environ Epidemiol 25, 187–199 (2015). https://doi.org/10.1038/jes.2014.43

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jes.2014.43

Keywords

This article is cited by

Search

Advanced search

Quick links