Original ContributionAssociation between rapid weather changes and incidence of chiefly cardiovascular complaints in the emergency department
Introduction
Cardiovascular disease (CVD) is a major social and health issue because it is still a leading cause of morbidity and mortality worldwide. The effect of seasonal variation in mortality from coronary artery disease was reported over 80 years ago [26]. Seasonal shift and variations in weather changes and in morbidity and mortality due to CVD have been investigated in several countries with differing climatic conditions. Overall, findings have been inconsistent.
Studies have demonstrated variations in CVD with respect to season and time of day [2,15,25,28,[36], [37], [38],40]. Changes in temperature and atmospheric pressure display daily and seasonal variations and could modulate the occurrence of vascular events [4,19,28,32,35]. For example, a number of studies showed that cold temperature is associated with a more frequent occurrence of myocardial infarction (MI) due to physiological changes (e.g., increase in plasma viscosity and serum cholesterol levels, blood pressure, sympathetic nerves activities, and platelet aggregation) [16,17,23,29,30]. Heat exposure is also well known to be associated with physiological changes (e.g., increased heart rate, blood viscosity, and coagulation) [20,23]. In 2014, Brightwell et al. [5] reported that an elevated risk of acute abdominal aortic aneurysm rupture was associated with changes in temperature and, in 2015, Rakers et al. [33] reported that rapid weather changes are associated with an increasing risk for ischemic strokes. Recently, Mohammad et al. showed in a large, nationwide study (Sweden) that low air temperature was associated with risk of MI. [28]. When reaching the hospital, many of these patients are admitted to emergency departments (ED) for immediate diagnosis and therapy and to determine further treatment strategy. However, for a single ED it is not clear whether changes in the weather are indeed relevant and should be considered, for example, by changing staffing or by modifying treatment protocols.
In recent years the number of interdisciplinary ED in hospitals in Germany has increased. Leipzig University Hospital also established a central ED in 2012. The Leipzig University Hospital is a 1350-bed, primary (highest-level) hospital in the central region of Germany and 36,000 patients are treated annually at the ED there.
The aim of this retrospective, single-center study was to evaluate whether rapid changes in weather conditions (temperature, atmospheric pressure, and relative humidity) are associated with a higher rate of ED admissions for CVD. Furthermore, the observed effects sizes were correlated with the overall variability of visits to the ED adjusted by day of the week in order to assess the relevance of the findings.
Section snippets
Aim of the study
The primary objective of the study was to clarify the relationship between rapid weather changes and visits in ED due to CVD. The primary endpoint was the ED attendance of patients with CVD. Therefore, from 1 January 2014 to 31 December 2015 the number of daily emergency admissions for CVD to the ED of the University Hospital of Leipzig, Germany, was investigated and was correlated with weather changes on the day before admission.
Patient data
Patients admitted for CVD to the ED were investigated. Here,
Patients and visits
During the study period the overall number of visits in the ED was 62,387 (2014: 30,489; 2015: 31,908). During the study period 32,887 [52.7%] male and 29,492 [47.3%] female patients visited the ED. For eight patients [0.01%] the gender was not defined due to documentation deficits during IT system downtime.
There was an average of 85 visits per day (range: 45–135; median: 85). The maximum was 135 and was reached on New Year's Day (2014-01-01). This can be attributed to the direct relationship
Discussion
In this case-crossover study, we investigated the association between ED visits and day-to-day changes in temperature, pressure, and relative humidity. Aim of the study was to determine whether changes in weather, by influencing the number of patients with CVD, might be relevant for ED protocols and personnel staffing and should thus be considered. We observed an association between rate of hospital admissions for CVD and rapid weather changes. To our knowledge, this is the first study to
Conclusion
We found an association between rapid weather changes and ED visits due to CVD. However, the observed significant effects are too small to draw any conclusions in terms of ED capacity due to weather changes.
Acknowledgements
We thank Torben K. Becker, MD, Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA, for his support and language correction.
Declaration of competing interest
The authors have no disclosures or conflicts of interest. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References (40)
- et al.
Impact of weather and climate on the incidence of acute coronary syndromes
Int J Cardiol
(2007) - et al.
Increased platelet and red cell counts, blood viscosity, and plasma cholesterol levels during heat stress, and mortality from coronary and cerebral thrombosis
Am J Med
(1986) - et al.
Temperature extremes and mortality from coronary heart disease and cerebral infarction in elderly Chinese
Lancet
(1995) - et al.
Climatological variations in daily hospital admissions for acute coronary syndromes
Int J Cardiol
(2004) - Abrignani MG, Corrao S, Biondo GB, Renda N, Braschi A, Novo G, Di Girolamo A, Braschi GB, Novo S. Influence of climatic...
- et al.
Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24,061 consecutive cases
Eur Heart J
(2000) - et al.
Weather, climate, and public health
J Epidemiol Community Health
(2003) - et al.
Seasonal variation in deep vein thrombosis
BMJ
(1996) - et al.
Changes in temperature affect the risk of abdominal aortic aneurysm rupture
ANZ J Surg
(2014) - et al.
Lower ambient temperature was associated with an increased risk of hospitalization for stroke and acute myocardial infarction in young women
J Clin Epidemiol
(2004)
Changes in seasonal deaths from myocardial infarction
QJM
CLimate Impacts on Myocardial infarction deaths in the Athens TErritory: the CLIMATE study
Heart
Seasonal variation in coronary heart disease in Scotland
J Epidemiol Community Health
Weather changes associated with hospitalizations for cardiovascular diseases and stroke in California, 1983-1998
Int J Biometeorol
A population-based study of the associations of stroke occurrence with weather parameters in Siberia, Russia (1982–92)
Eur J Neurol
Weather, Chinook and stroke occurrence
Stroke
Differential effects of temperature extremes on hospital admission rates for respiratory disease between indigenous and non-indigenous Australians in the northern territory
Int J Environ Res Public Health
Effects of temperature and snowfall on mortality in Pennsylvania
Am J Epidemiol
Associations of cold temperatures with GP consultations for respiratory and cardiovascular disease amongst the elderly in London
Int J Epidemiol
Public health vulnerability to wintertime weather: time-series regression and episode analyses of national mortality and morbidity databases to inform the Cold Weather Plan for England
Public Health
Cited by (3)
No impact of weather conditions on the outcome of intensive care unit patients
2022, Wiener Medizinische WochenschriftAn effect of 24-hour temperature change on outpatient and emergency and inpatient visits for cardiovascular diseases in northwest China
2021, Environmental Science and Pollution ResearchBody, indoor, outdoor temperature- A nd arterial blood pressure
2021, Journal of Hypertension