Background Environmental health risks for individuals with heart failure ( HF ) have been inadequately studied, as these individuals are not well represented in traditional cohort studies. To address this we studied associations between long‐term air pollution exposure and mortality in HF patients. Methods and Results The study population was a hospital‐based cohort of individuals diagnosed with HF between July 1, 2004 and December 31, 2016 compiled using electronic health records. Individuals were followed from 1 year after initial diagnosis until death or the end of the observation period (December 31, 2016). We used Cox proportional hazards models to evaluate the association of annual average fine particulate matter ( PM 2.5 ) exposure at the time of initial HF diagnosis with all‐cause mortality, adjusted for age, race, sex, distance to the nearest air pollution monitor, and socioeconomic status indicators. Among 23 302 HF patients, a 1 μg/m 3 increase in annual average PM 2.5 was associated with an elevated risk of all‐cause mortality (hazard ratio 1.13; 95% CI, 1.10–1.15). As compared with people with exposures below the current national PM 2.5 exposure standard (12 μg/m 3 ), those with elevated exposures experienced 0.84 (95% CI, 0.73–0.95) years of life lost over a 5‐year period, an observation that persisted even for those residing in areas with PM 2.5 concentrations below current standards. Conclusions Residential exposure to elevated concentrations of PM 2.5 is a significant mortality risk factor for HF patients. Elevated PM 2.5 exposures result in substantial years of life lost even at concentrations below current national standards.

Background Long‐term air pollution exposure is a significant risk factor for inpatient hospital admissions in the general population. However, we lack information on whether long‐term air pollution exposure is a risk factor for hospital readmissions, particularly in individuals with elevated readmission rates. Methods and Results We determined the number of readmissions and total hospital visits (outpatient visits+emergency room visits+inpatient admissions) for 20 920 individuals with heart failure. We used quasi‐Poisson regression models to associate annual average fine particulate matter at the date of heart failure diagnosis with the number of hospital visits and 30‐day readmissions. We used inverse probability weights to balance the distribution of confounders and adjust for the competing risk of death. Models were adjusted for age, race, sex, smoking status, urbanicity, year of diagnosis, short‐term fine particulate matter exposure, comorbid disease, and socioeconomic status. A 1‐µg/m 3 increase in fine particulate matter was associated with a 9.31% increase (95% CI, 7.85%–10.8%) in total hospital visits, a 4.35% increase (95% CI, 1.12%–7.68%) in inpatient admissions, and a 14.2% increase (95% CI, 8.41%–20.2%) in 30‐day readmissions. Associations were robust to different modeling approaches. Conclusions These results highlight the potential for air pollution to play a role in hospital use, particularly hospital visits and readmissions. Given the elevated frequency of hospitalizations and readmissions among patients with heart failure, these results also represent an important insight into modifiable environmental risk factors that may improve outcomes and reduce hospital use among patients with heart failure.

Renal dysfunction is prevalent in the US among African Americans. Air pollution is associated with renal dysfunction in mostly white American populations, but not among African Americans. We evaluated cross-sectional associations between 1-year and 3-year fine particulate matter (PM 2.5 ) and ozone (O 3 ) concentrations and renal function among 5090 African American participants in the Jackson Heart Study. We used mixed-effect linear regression to estimate associations between 1-year and 3-year PM 2.5 and O 3 and estimated glomerular filtration rate (eGFR), urine albumin/creatinine ratio (UACR), serum creatinine, and serum cystatin C, adjusting for: sociodemographic factors, health behaviors, and medical history and accounting for clustering by census tract. At baseline, JHS participants had mean age 55.4 years, and 63.8% were female; mean 1-year and 3-year PM 2.5 concentrations were 12.2 and 12.4 μg/m 3 , and mean 1-year and 3-year O 3 concentrations were 40.2 and 40.7 ppb, respectively. Approximately 6.5% of participants had reduced eGFR (<60 mL/min/1.73m 2 ) and 12.7% had elevated UACR (>30 μg/g), both indicating impaired renal function. Annual and 3-year O 3 concentrations were inversely associated with eGFR and positively associated with serum creatinine; annual and 3year PM 2.5 concentrations were inversely associated with UACR. We observed impaired renal function associated with increased O 3 but not PM 2.5 exposure among African Americans.