Short‑term effects of ambient air pollution exposure on hospital emergency room visits for atrial fibrillation: a nationwide cohort study

Abstract

Background

Although air pollutants are linked to cardiopulmonary mortality, their impact on cardiac arrhythmias is not well understood. This study examines the short-term effects of air pollution on emergency admissions for acute atrial fibrillation (AF) in Taiwan.

Methods

This study used Taiwan’s National Health Insurance Research Database, including 16,778,374 participants aged 20 and older, residing in the same districts during 10-year follow-ups from 2008 to 2017. Hourly air pollutant exposure data were obtained from the Taiwan Environmental Protection Administration Database. Records of patients with ICD-9 code 427.31 (AF) as the primary diagnosis from emergency departments were extracted. Emergency visits for AF were compared across exposures to pollutants such as particulate matter PM_2.5, PM₁₀, Nitrogen Dioxide (NO₂), Nitrogen Oxide (NO), Nitrogen Oxides (NO_X), Sulphur Dioxide (SO₂), Carbon monoxide (CO) and Ozone (O₃).

Results

In our study cohort of 16,778,374 patients, 129,595 (0.77 %) were admitted to emergency departments for initial AF episodes. Significant associations were found between AF visits and PM_2.5 (1.01 %; CI: 1.00–1.02 %; P = 0.003), PM₁₀ (1.01 %; CI: 1.00–1.01 %; P = 0.001), NO₂ (1.02 %; CI: 1.00–1.03 %; P = 0.001), NO (1.02 %; CI: 1.00–1.04 %; P = 0.016), NO_x (1.01 %; CI: 1.00–1.01 %; P = 0.002), CO (1.05 %; CI: 1.00–1.11 %; P < 0.0001), with exposure levels on the event day compared to the previous 5 days. Except for O₃, patients without comorbidities like coronary artery disease, heart failure, chronic kidney disease, and thyroid disease were more susceptible to air pollution.

Conclusions

High concentrations of ambient air pollutants with short-term exposure are linked to an increased number of emergency room visits for acute AF attacks.