title: The association between meteorological events and acute heart failure: new insights from ASCEND-HF.
abstract: BACKGROUND
  Given the rising prevalence of heart failure (HF), our objective is to explore the relationships between meteorological events and acute HF (AHF) globally.
  
  
  METHODS
  We used data from 30 countries participating in the ASCEND-HF trial. Parameters including temperature were normalized by location for the 37 days prior to the HF event. Meteorological events were classified as a change that occurred <10% compared to baseline. The 7 days prior to the HF event was subdivided: T1: the day of and -1 day; T2: 2 and 3 days; T3: 4 and 5 days; and T4: 6 and 7 days. Results are reported as ratios of observed to expected weather events at the time of AHF presentation.
  
  
  RESULTS
  From 7141 patients, median age was 67 (IQR 56-76) with 66% male patients and 60% of patients with ischemic cardiomyopathy. In T1, temperatures were warmer than expected with 10% fewer decreases in average [OR 0.91 95% CI (0.83-0.98)] and minimum [OR 0.90 95% CI (0.82-0.97)] temperature. In T2, temperatures were again warmer than expected with an excess number of increases in maximum [OR 1.18 95% CI (1.06-1.30)] and average [OR 1.21 95% CI (1.10-1.32)] temperature. In T4 temperatures were cooler than baseline with fewer increases [OR 0.84 95% CI (0.74-0.95)] in average temperature.
  
  
  CONCLUSIONS
  Meteorological fluctuations appear most relevant in the 3 days (T1 and T2) prior to the HF hospitalization with temperature demonstrating a bidirectional relationship with AHF. Continued validation of biometeorological trends in HF will contribute to healthcare system planning globally.
authors.affiliation: University of Alberta, Edmonton, Canada.
authors.forename: Debraj
authors.initials: D
authors.lastname: Das
authors.affiliation: Patient Health Outcomes and Clinical Effectiveness Unit, University of Alberta, Edmonton, Canada.
authors.forename: Jeffery A
authors.initials: JA
authors.lastname: Bakal
authors.affiliation: University of Alberta, Edmonton, Canada; Canadian VIGOUR Centre at the University of Alberta, Edmonton, Canada.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Westerhout
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Oslo University Hospital, Norway.
authors.forename: Dan
authors.initials: D
authors.lastname: Atar
authors.affiliation: University of Glasgow, Scotland.
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.affiliation: University of Alberta, Edmonton, Canada; Canadian VIGOUR Centre at the University of Alberta, Edmonton, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.affiliation: University of Alberta, Edmonton, Canada; Canadian VIGOUR Centre at the University of Alberta, Edmonton, Canada. Electronic address: jae2@ualberta.ca.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
mesh_terms: D000208:Acute Disease; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D006813:Humidity / Q000009:adverse effects*; D038622:Internationality; D008297:Male; D008685:Meteorological Concepts; D008875:Middle Aged; D013696:Temperature; D014887:Weather; D014919:Wind
keywords: Acute heart failure; Clinical trials; Multicenter studies; Weather events