Background: A seasonal variation in hospital admissions in patients with heart failure (HF) has been described and most admissions occur during the winter season. The effect of this seasonal variation on prognosis is less clear. Objectives: To evaluate the effect of the seasonal timing of hospital admission on clinical outcome in patients with HF. Methods: We prospectively enrolled 362 consecutive patients hospitalized with a definite clinical diagnosis of HF during a 2-year period. Patients were followed clinically for a period of 1 year. Results: There was a prominent seasonal variation in hospital admissions in patients with HF with peak admissions during the winter. The admission rate inversely correlated with the average monthly temperature. Admission during the summer season was a significant predictor of reduced survival (59 vs. 75%, p < 0.01). Cox regression analysis demonstrated that independent predictors of reduced survival after adjustment for other predictors were admission during the hottest 6 months or admission during the summer. In addition, increased mean environmental admission temperature was an independent predictor of reduced survival. Conclusions: Seasonal temperature has a significant effect on the rate of hospital admission in patients with HF. Admission during warmer weather is a sign of a poor prognosis.

Keywords:
Seasonal variation, Heart failure, Hospital admission
1.
Gotsman I, Zwas D, Planer D, Azaz-Livshits T, Admon D, Lotan C, Keren A: Clinical outcome of patients with heart failure and preserved left ventricular function. Am J Med 2008;121:997–1001.
2.
Boulay F, Berthier F, Sisteron O, Gendreike Y, Gibelin P: Seasonal variation in chronic heart failure hospitalizations and mortality in France. Circulation 1999;100:280–286.
3.
Stewart S, McIntyre K, Capewell S, McMurray JJ: Heart failure in a cold climate. Seasonal variation in heart failure-related morbidity and mortality. J Am Coll Cardiol 2002;39:760–766.
4.
Feldman DE, Platt R, Dery V, Kapetanakis C, Lamontagne D, Ducharme A, Giannetti N, Frenette M, Beck EJ: Seasonal congestive heart failure mortality and hospitalisation trends, Quebec 1990–1998. J Epidemiol Community Health. 2004;58:129–130.
5.
Diaz A, Ferrante D, Badra R, Morales I, Becerra A, Varini S, Nul D, Grancelli H, Doval H: Seasonal variation and trends in heart failure morbidity and mortality in a South American community hospital. Congest Heart Fail 2007;13:263–266.
6.
Ogawa M, Tanaka F, Onoda T, Ohsawa M, Itai K, Sakai T, Okayama A, Nakamura M: A community based epidemiological and clinical study of hospitalization of patients with congestive heart failure in Northern Iwate, Japan. Circ J 2007;71:455–459.
7.
Inglis SC, Clark RA, Shakib S, Wong DT, Molaee P, Wilkinson D, Stewart S: Hot summers and heart failure: seasonal variations in morbidity and mortality in Australian heart failure patients (1994–2005). Eur J Heart Fail 2008;10:540–549.
8.
Ansa VO, Ekott JU, Essien IO, Bassey EO: Seasonal variation in admission for heart failure, hypertension and stroke in Uyo, South-Eastern Nigeria. Ann Afr Med 2008;7:62–66.
9.
Danet S, Richard F, Montaye M, Beauchant S, Lemaire B, Graux C, Cottel D, Marecaux N, Amouyel P: Unhealthy effects of atmospheric temperature and pressure on the occurrence of myocardial infarction and coronary deaths. A 10-year survey: The Lille-World Health Organization MONICA project (Monitoring Trends And Determinants In Cardiovascular Disease). Circulation 1999;100:E1–E7.
10.
Spencer FA, Goldberg RJ, Becker RC, Gore JM: Seasonal distribution of acute myocardial infarction in the second national registry of myocardial infarction. J Am Coll Cardiol 1998;31:1226–1233.
11.
Youn JC, Rim SJ, Park S, Ko YG, Kang SM, Choi D, Ha JW, Jang Y, Chung N: Arterial stiffness is related to augmented seasonal variation of blood pressure in hypertensive patients. Blood Press 2007;16:375–380.
12.
Martinez-Selles M, Garcia Robles JA, Prieto L, Serrano JA, Munoz R, Frades E, Almendral J: Annual rates of admission and seasonal variations in hospitalizations for heart failure. Eur J Heart Fail 2002;4:779–786.
13.
Jorge JE, Cagy M, Mesquita ET, Costa TL, Moscavitch SD, Rosa ML: Seasonal variation in hospitalizations due to heart failure in Niteroi city, Southeastern Brazil. Rev Saude Publica 2009;43:555–557.
14.
Aronow WS, Ahn C: Seasonal variation of deaths from fatal myocardial infarction, primary cardiac arrest, sudden cardiac death, and refractory congestive heart failure in older persons living in New York city. J Am Med Dir Assoc 2000;1:258–260.
15.
Sandoval C, Walter SD, Krueger P, Smieja M, Smith A, Yusuf S, Loeb MB: Risk of hospitalization during influenza season among a cohort of patients with congestive heart failure. Epidemiol Infect 2007;135:574–582.
16.
Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM: Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 2006;355:251–259.
17.
Felker GM, Thompson RE, Hare JM, Hruban RH, Clemetson DE, Howard DL, Baughman KL, Kasper EK: Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med 2000;342:1077–1084.
18.
Gheorghiade M, Abraham WT, Albert NM, Gattis Stough W, Greenberg BH, O’Connor CM, She L, Yancy CW, Young J, Fonarow GC: Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 2007;28:980–988.
19.
Oren RM: Hyponatremia in congestive heart failure. Am J Cardiol 2005;95:2B–7B.
20.
Barnett AG, de Looper M, Fraser JF: The seasonality in heart failure deaths and total cardiovascular deaths. Aust NZ J Public Health 2008;32:408–413.
21.
Oktay C, Luk JH, Allegra JR, Kusoglu L: The effect of temperature on illness severity in emergency department congestive heart failure patients. Ann Acad Med Singapore 2009;38:1081–1084.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.