Air quality and the risk of acute atrial fibrillation (EP-PARTICLES study): A nationwide study in Poland.

Abstract

Aim: Air pollution remains the single largest environmental health risk factor, while atrial fibrillation (AF) is the most prevalent arrhythmia globally. The study aimed to investigate the relationship between short-term exposure to air pollution and acute AF admissions.

Methods: Individual data on AF hospitalization in the years 2011-2020 were collected from the National Health Fund in Poland (ICD-10: I48.XX). To obtain high-resolution data on air pollution we applied a modelling method using the GEM-AQ model. Associations between air pollution exposure and acute AF admissions were estimated using generalized additive models with Poisson regression.

Results: Over the analysed period, we recorded 252,566 acute admissions due to AF. Each 10 µg/m3 increment of PM2.5 and NO2 concentration, 1 µg/m3 of SO2 and 10 ng/m3 of benzo(a)pyrene (BaP) concentration on the day of exposure resulted in 1.13% (0.70%-1.55%), 1.65% (1.05%-2.26%), 0.11% (0.01%-0.21%), and 0.3% (0.04%-0.55%) increases in acute AF admissions, respectively. The estimates are larger for women and older people. Stronger associations between PM2.5 and BaP concentrations and AF admissions in poorly urbanized areas were noted. Areas with high gross domestic product levels were more affected by the increase in NO2 concentrations, resulting in a 0.2% (1.001-1.003) increase in AF admissions. Exposure-response functions show steeper slopes of the pollutant-outcome associations in the lower ranges of exposures, far below World Health Organization (WHO) air quality guideline norms. For the zero-emission scenario, we estimate avoidable AF admissions - 5,873 for PM2.5 (95% CI 3,679 to 8,047) and 3,295 for NO2 (2,108-4,477).

Conclusions: Air pollution acts as a triggering factor and can be associated with acute AF hospitalisations. PM2.5 and NO2 have an impact on AF even at concentrations levels below WHO air quality guideline norms.