title: Heart failure and the holidays.
abstract: BACKGROUND
  Studies suggest increased cardiac morbidity and heart failure exacerbations during winter months with a peak around the holiday season. Major sporting events and intense encounters in sports have been shown to affect cardiovascular outcomes amongst its fans.
  
  
  METHODS
  All patients admitted to Einstein Medical Center between January 1, 2003 and December 31, 2013 with a diagnosis of congestive heart failure were included in the study. They were included on the basis of the presence of an ICD-9CM code representing congestive heart failure as the primary diagnosis. Comparisons were made between the rates of heart failure admissions on the holiday, 4 days following the holiday and the rest of the month for 5 specific days: Christmas day, New Year's day, Independence day, Thanksgiving day and Super Bowl Sunday.
  
  
  RESULTS
  Our study included 22,727 heart failure admissions at an average of 5.65 admissions per day. The mean patient age was 68 ± 15 years. There was a significant increase in daily heart failure admissions following Independence day (5.65 vs. 5; p = 0.027) and Christmas day (6.5 vs. 5.5; p = 0.046) when compared to the rest of the month. A history of alcohol abuse or dependence did not correlate with the reported+ rise in heart failure admissions immediately following the holidays. The mean number of daily admissions on the holidays were significantly lower for all holidays compared to the following 4 days. All holidays apart from Super Bowl Sunday demonstrated lower admission rates on the holiday compared to the rest of the month.
  
  
  CONCLUSIONS
  Christmas and Independence day were associated with increased heart failure admissions immediately following the holidays. The holidays themselves saw lower admission rates. Overeating on holidays, associated emotional stressors, lesser exercise and postponing medical around holidays may be among the factors responsible for the findings.
authors.affiliation: Department of Cardiology, Lehigh Valley Hospital Network, 1250S Cedar Crest Blvd, Suite 300, Allentown, PA, 18103, USA. Mahek.shah@lvhn.org.
authors.forename: Mahek
authors.initials: M
authors.lastname: Shah
authors.affiliation: Department of Cardiology, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Bhalla
authors.affiliation: Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Soumya
authors.initials: S
authors.lastname: Patnaik
authors.affiliation: Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Obiora
authors.initials: O
authors.lastname: Maludum
authors.affiliation: Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Marvin
authors.initials: M
authors.lastname: Lu
authors.affiliation: Department of Cardiology, Einstein Medical Center, Philadelphia, PA, USA.|Sydney Kimmel Medical College, Philadelphia, PA, USA.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Figueredo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D018450:Disease Progression; D004644:Emotions; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D006693:Holidays / Q000523:psychology; D006801:Humans; D006963:Hyperphagia / Q000150:complications; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D015143:Philadelphia; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012621:Seasons; D057185:Sedentary Behavior; D013177:Sports / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology; D013997:Time Factors
keywords: Christmas; Heart failure; Holiday; Independence day; New year; Over-eating; Super Bowl; Thanksgiving