Modification of the Association Between PM2.5 and Heart Rate by Beta-Blocker Usage Among Heart Failure Patients
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Fine particulate matter (PM2.5) is a ubiquitous ambient air pollutant associated with cardiovascular morbidity, particularly among individuals with pre-existing conditions such as heart failure (HF). Medications may modify the association between PM2.5 and health risks, particularly those that act on the same physiologic pathways as PM2.5. Using electronic health records (EHRs) from 26,653 HF patients from 2014-2016, we examined whether associations between heart rate (HR) and PM2.5 were modified by beta-blocker medication usage. Daily PM2.5 was measured at the EPA air quality monitor closest to the patient’s primary residence. After adjusting models for age, sex, race, temperature, relative humidity, census sociodemographic variables, and a cubic spline over time since start, associations were stratified on beta-blocker medication usage and examined for the day of measurement and up to 4 days prior as well as the 5-day moving average. A multiplicative interaction was also used to model the interaction between PM2.5 and HR. Results are per 10 . Associations across lags were consistent, so we will report only the 5-day moving averages. When no beta-blocker prescription was noted in the health record, we observed a positive association between PM2.5 and HR (0.79, CI = 0.67, 0.92) with the opposite direction of association seen when beta-blockers had been prescribed (-0.21, CI = -0.28, -0.15; interaction p = 2.18x10-25). Medication usage likely has interactions with short-term PM2.5 and should be accounted for when possible and potentially explored for its ability to modify PM2.5-related health risks. This abstract does not necessarily reflect the policies of the US EPA.