Low ambient temperature increases the risk and burden of atrial fibrillation episodes: A nationwide case-crossover study in 322 Chinese cities

Abstract

Background: Non-optimum ambient temperature has recently been acknowledged as an independent risk factor for disease burden, but its impact on atrial fibrillation (AF) episodes was rarely evaluated.

Objectives: To examine the associations between ambient non-optimum temperature and symptom onset of AF episodes and calculate the corresponding disease burden.

Methods: We conducted an individual-level, time-stratified, case-crossover analysis based on a nationwide registry, which comprises of 94,711 eligible AF patients from 1993 hospitals in 322 Chinese cities from January 2015 to December 2021. Multiple moving 24 h average temperatures prior to the symptom onset of AF episodes were calculated as lag days. The associations were analyzed using conditional logistic regression combined with distributed lag non-linear models with a duration of lag 0-7 days, after controlling for criteria air pollutants. Stratification analyses were performed to explore possible effect modifiers.

Results: There was a monotonically increasing relationship of AF onset risk with decreasing temperature. The excess AF risk occurred at lag 1 d and lasted for 5 days. Nationally, the cumulative relative risk of AF episode onset associated with extremely low temperature (-9.3 °C) over lag 0-7 d was 1.25 (95 % confidence interval: 1.08, 1.45), compared with the reference temperature (31.5 °C). The exposure-response curve was steeper in the south than in the north where there was levelling-off at lower temperature. Nationally, 7.59 % of acute AF episodes could be attributable to non-optimum temperatures. The attributable fraction was larger for southern residents, males and patients <65 years.

Conclusion: This nationwide study provides novel and robust evidence that declining ambient temperature could increase the risk of AF episode onset. We also provide the first-hand evidence that a considerable proportion of acute AF episodes could be attributable to non-optimum temperatures.

Keywords: Ambient temperature; Atrial fibrillation; Case-crossover; Disease burden.