Dataset Information

Prescribed fires, smoke exposure, and hospital utilization among heart failure patients.

ABSTRACT:

Background

Prescribed fires often have ecological benefits, but their environmental health risks have been infrequently studied. We investigated associations between residing near a prescribed fire, wildfire smoke exposure, and heart failure (HF) patients' hospital utilization.

Methods

We used electronic health records from January 2014 to December 2016 in a North Carolina hospital-based cohort to determine HF diagnoses, primary residence, and hospital utilization. Using a cross-sectional study design, we associated the prescribed fire occurrences within 1, 2, and 5 km of the patients' primary residence with the number of hospital visits and 7- and 30-day readmissions. To compare prescribed fire associations with those observed for wildfire smoke, we also associated zip code-level smoke density data designed to capture wildfire smoke emissions with hospital utilization amongst HF patients. Quasi-Poisson regression models were used for the number of hospital visits, while zero-inflated Poisson regression models were used for readmissions. All models were adjusted for age, sex, race, and neighborhood socioeconomic status and included an offset for follow-up time. The results are the percent change and the 95% confidence interval (CI).

Results

Associations between prescribed fire occurrences and hospital visits were generally null, with the few associations observed being with prescribed fires within 5 and 2 km of the primary residence in the negative direction but not the more restrictive 1 km radius. However, exposure to medium or heavy smoke (primarily from wildfires) at the zip code level was associated with both 7-day (8.5% increase; 95% CI = 1.5%, 16.0%) and 30-day readmissions (5.4%; 95% CI = 2.3%, 8.5%), and to a lesser degree, hospital visits (1.5%; 95% CI: 0.0%, 3.0%) matching previous studies.

Conclusions

Area-level smoke exposure driven by wildfires is positively associated with hospital utilization but not proximity to prescribed fires.

SUBMITTER: Raab H

PROVIDER: S-EPMC10717133 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Publications

Prescribed fires, smoke exposure, and hospital utilization among heart failure patients.

Raab Henry H Moyer Joshua J Afrin Sadia S Garcia-Menendez Fernando F Ward-Caviness Cavin K CK

Environmental health : a global access science source 20231213 1

<h4>Background</h4>Prescribed fires often have ecological benefits, but their environmental health risks have been infrequently studied. We investigated associations between residing near a prescribed fire, wildfire smoke exposure, and heart failure (HF) patients' hospital utilization.<h4>Methods</h4>We used electronic health records from January 2014 to December 2016 in a North Carolina hospital-based cohort to determine HF diagnoses, primary residence, and hospital utilization. Using a cross-s ...[more]

PMID: 38087300

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Project description:Background and objectivesHeart failure (HF) is one of the leading causes of morbidity and mortality, and economic burden on the healthcare system. The aim of this study was to estimate the current hospital resource utilization and costs for HF patients in France.MethodsThis retrospective cohort study included adult HF patients hospitalized in France between January 1, 2019 and December 31, 2019. Data related to sociodemographic characteristics, number and duration of hospital stays, use of medical procedures or expensive and innovative drugs/medical devices included in the "liste-en-sus", and comorbidities were retrieved from the French national hospital discharge database. Data were further stratified based on the presence or absence of cardiac decompensation, comorbidities, ejection fraction (EF) status, and incident/prevalent patients.ResultsIn 2019, a total of 430,544 patients were hospitalized in France with HF as a primary or associated diagnosis, with 51.9% male and 48.1% female and a mean age of 79.0 years. More than 75% of the study population was composed of prevalent HF patients. About 3.1% of patients were diagnosed with at least one event of cardiac decompensation during follow-up. Also, 20.2% and 9.9% of patients were identified with preserved and reduced EFs, respectively. The average number and length of hospital stays were 1.7 per patient and 10.4 days per patient, respectively. The annual cost of hospitalization for HF was €8341.3 per patient. Presence of cardiac decompensation at index date or during follow-up, reduced EF, and comorbidities were associated with numerically higher frequency and length of hospitalization, and hospitalization cost. For hospitalization and 'liste-en-sus' medical devices, higher cost was observed in incident than prevalent HF patients, while for 'liste-en-sus' drugs, higher cost was reported in prevalent than incident HF patients.ConclusionThis study highlighted the high economic hospital burden of HF in France. More studies investigating different HF patient profiles must be conducted to help determine the main factors of hospital cost for HF.

Project description:Background: Heart failure (HF) is a significant cause of mortality, morbidity and impaired quality of life and is the leading cause of readmissions and hospitalization. This study aims to identify the factors contributing to readmission in patients with HF. Methods: A prospective-observational single-centre study was conducted in Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates. A total of 146 patients with HF are included in the study. Patient's demographics, patient medical characteristics, lab values, medications were collected for each patient, and the factors associated with readmission are identified. The primary outcome is to identify the factors contributing to readmission and reduce readmission rate. SPSS software for windows version 26 is used for data analysis. Results: The number of patients with heart failure admitted to hospital is higher with males (73.3%) than females. 42.1% were readmitted and were not compliant, whereas patients who are not readmitted and were compliant shows a lower percentage. Noncompliance was the most significant factor associated with readmission (p = 0.02, OR = 3.6, 95%CI: 1.57 - 8.28). Other factors that are associated with readmission were low haemoglobin (p = 0.001, OR = 0.96, 95%CI: 0.94 - 0.98), and NYHA class of HF (p = 0.023, OR = 2.22, 95%CI: 1.12 - 4.43). In addition, there are other factors that are linked with the disease but were not associated with readmission in our findings such as hypertension, coronary artery disease, gender, systolic blood pressure on admission, and age. Majority of the readmitted patients were NYHA Class IV 32/57 (56.1%) against 20/89 (22.7%) in non-readmission group. Length of stay is (Median ± IQR, 6 ± 8.5). Conclusion: The study has revealed that noncompliance, low haemoglobin and NYHA Class IV of HF were the main factors associated with readmission. Clinical pharmacist as a team member could help to improve adherence in order to reduce the rate of admission.

Dataset Information

Prescribed fires, smoke exposure, and hospital utilization among heart failure patients.

Background

Methods

Results

Conclusions

Publications

Prescribed fires, smoke exposure, and hospital utilization among heart failure patients.

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