The air we breathe in - the impact of air pollution on hospitalized morbidity due to atrial fibrillation (EP-PARTICLES study)
Authors: Kurasz A , Dabrowski E J , Swieczkowski M , Tomaszuk-Kazberuk A , Bachorzewska-Gajewska H , Dobrzycki S , Kuzma L 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is the most common arrhythmia and environmental conditions are one of its risk factors. While the etiology of AF is multifactorial and includes other cardiovascular diseases like heart failure, some studies suggest that air pollution may play an important role in its development and progression. So far, they focus on the short-term influence of pollutants and mainly on particulate matters (PMs). Moreover, the type of pollution that occurs in Poland, called "Polish smog" - due to its composition and the conditions in which it is formed - is characterized by extremely adverse health effects.

Purpose
Analysis of the impact of air pollution on triggering atrial fibrillation episodes.

Methods
The study area included voivodeships of Eastern Poland. Data on hospitalizations for 2011-2020 were obtained from regional departments of the National Health Fund resulting in 882,277 hospitalizations. Non-emergency hospitalizations were excluded from further analysis. In the statistical analysis, the time-stratified panel data using Poisson regression techniques has been estimated. Day of the week, temperature, atmospheric pressure, and humidity with cubic spline transformation (df=3) were used as confounders. For long-term trends, a simple indicator variable technique was used. The association between PMs and the occurrence of AF is presented as odds ratios (OR) with 95% confidence intervals (CI). ORs for each pollutant at days with lag from 0 to 6, 0-6, and 0-30 were calculated separately.

Results
During the analysed period, a total of 311,645 hospitalizations for AF were recorded, including 252,566 emergency ones. The main pollutant affecting the occurrence of AF episodes was benzo(a)pyrene (BaP) – a 1 mg/m3 increase in BaP concentrations (lag0-OR=1.078, 95%CI 1.054-1.102; P&lt;0.001) resulted in an increase in emergency hospitalizations for AF. Hospitalized morbidity due to atrial fibrillation was also influenced by PM2.5 (lag0-OR=1.035, 95%CI 1.031-1.039; P&lt;0.001), SO2 (lag0-OR=1.015, 95%CI 1.007-1.023; P&lt;0.001), and NO2 (lag0-OR=1.022, 95%CI 1.016-1.027; P&lt;0.001). This effect persisted for 7 days [lag0-6 (BaP-OR=1.121, 95%CI 1.09-1.153; P&lt;0.001), (PM2.5-OR=1.047, 95%CI 1.042-1.052; P&lt;0.001), (SO2-OR=1.032, 95%CI 1.022-1.043; P&lt;0.001), (NO2-OR=1.032, 95%CI 1.024-1.041; P&lt;0.001)].

Conclusions
Variations in air pollution levels, especially BaP and PM2.5, can increase the risk of acute AF incidents. We associate these pronounced adverse health effects with the particularly toxic effects of Polish smog. There is a need for further research that will focus on the mid– and long–term effects of pollution on AF which will help to elucidate the underlying pathomechanisms and develop effective strategies for prevention. Reducing air pollution levels may have significant public health benefits in terms of lowering the burden of AF and other cardiovascular diseases.Graphical abstract