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“Bushfire Season” in Australia: Determinants of increases in risk of acute coronary syndromes and Takotsubo Syndrome

  • Gao Jing Ong
    Affiliations
    Cardiology Research Laboratory, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, Australia, 5011

    University of Adelaide, Adelaide, Australia 5005.

    Cardiology Dept, Central Adelaide Local Health Network, Adelaide, Australia 5000
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  • Alexander Sellers
    Affiliations
    Cardiology Dept, Central Adelaide Local Health Network, Adelaide, Australia 5000
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  • Gnanadevan Mahadavan
    Affiliations
    Cardiology Dept, Central Adelaide Local Health Network, Adelaide, Australia 5000

    Cardiology Dept, Northern Adelaide Local Health Network, Elizabeth Vale, Australia, 5112
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  • Thanh H Nguyen
    Affiliations
    Cardiology Research Laboratory, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, Australia, 5011

    University of Adelaide, Adelaide, Australia 5005.
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  • Matthew I Worthley
    Affiliations
    University of Adelaide, Adelaide, Australia 5005.

    Cardiology Dept, Central Adelaide Local Health Network, Adelaide, Australia 5000
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  • Derek P Chew
    Affiliations
    South Australian Health and Medical Research Institute, Adelaide, Australia, 5000

    College of Medicine and Public Health, Flinders University, Australia 5042
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  • John D Horowitz
    Correspondence
    Corresponding author: Professor John D Horowitz, University of Adelaide, Department of Cardiology, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, 28 Woodville Road Woodville South, Adelaide, SA 5021, Australia, Phone: +61 457827046
    Affiliations
    Cardiology Research Laboratory, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, Australia, 5011

    University of Adelaide, Adelaide, Australia 5005.
    Search for articles by this author
Published:September 01, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.08.013

      Clinical significance

      • In summer, the combination of greater than mean temperature, PM2.5 concentration ≥25 mg/m3, and presence of a bushfire within 200km doubles the risk of acute coronary syndromes.
      • Risk of Takotsubo Syndrome is not substantially altered under these circumstances.
      • Our study findings are likely to be relevant to many other parts of the world, and should inform health care planning for the increasingly common presence of such risk factors.

      Abstract

      Background

      Climate change has resulted in an increase in ambient temperatures during the summer months, and also an increase in risk of associated air pollution and of potentially disastrous bushfires throughout much of the world. The increasingly frequent combination of elevated summer temperatures and bushfires may be associated with acute increases in risks of cardiovascular events, but this relationship remains unstudied. We evaluated the individual and cumulative impacts of daily fluctuations in temperature, fine particle(PM2.5) pollution and presence of bushfires on incidence of acute coronary syndromes and Takotsubo Syndrome.

      Methods

      From 1st November 2019 to 28th February 2020, all acute admissions with acute coronary syndromes or Takotsubo Syndrome to South Australian tertiary public hospitals were evaluated. Univariate and combined associations were sought between each of (1) maximal daily temperature, (2) PM2.5 concentrations, and (3) presence of active bushfires within 200km of the hospitals concerned.

      Results

      504 patients with acute coronary syndromes and 35 with Takotsubo Syndrome were studied. In isolation, increasing temperature was associated(rs=0.26,p=0.005) with increased incidence of acute coronary syndromes, while there were similar, but non-significant correlations for PM2.5 and presence of bushfires. Combinations of all these risk factors were also associated with a doubling of risk of acute coronary syndromes. No significant associations were found for Takotsubo Syndrome.

      Conclusion

      The combination of high temperatures, presence of bushfires and associated elevation of atmospheric PM2.5 concentrations represents a substantially increased risk for precipitation of acute coronary syndromes: this risk should be factored into health care planning including public education and acute hospital preparedness.

      Keywords

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