Heart failure (HF) patients who live in communities affected by unconventional natural gas development (UNGD), more commonly known as "fracking," may be at increased risk for hospitalization, according to a study published Dec. 7 in the Journal of the American College of Cardiology. The study looked at the environmental exposure risk of thousands of HF patients across Pennsylvania.

The researchers aimed to evaluate the association of UNGD activity and hospitalization among HF patients. Based on electronic health record data, the researchers used residential addresses to identify 12,330 HF patients who resided in 37 Pennsylvania counties from 2008 to 2015. Of these patients, 5,839 were hospitalized for HF. The researchers studied the first hospitalization identified for each patient.

The researchers observed stronger associations with UNGD activity in both HF with reduced ejection fraction and HF with preserved ejection fraction patients, suggesting both sets of HF phenotypes are equally susceptible to exposures related to UNGD. These associations can be attributed to the environmental impacts of fracking, including air pollution, water contamination, and noise, traffic and community impacts. Air pollutants can affect individuals across large regions, and due to the high volume of truck traffic to the UNGD sites, the noise, vibration and diesel exhaust can be spread over a large network of roads.

"We observed exposure-effect relations for three of the four unconventional natural gas development activity metrics and HF hospitalizations. The largest magnitude associations were observed for the well pad preparation, stimulation and production metrics," said Tara McAlexander, PhD, MPH, lead author of the study. "Our findings suggest that individuals living with HF, when exposed to greater UNGD activity, are more likely to be hospitalized, particularly in those with more severe HF at baseline."

The study limitations included using a less specific method to identify HF cases, as well as a lack of information on dietary intake and physical activity. In addition, the study did not include information on patient occupation.

In an accompanying editorial comment, Barrak Alahmad, MBChB, MPH, and Haitham Khraishah, MD, note that "In the early 2010s, the scientific community was calling for 'good' epidemiological studies in order to evaluate the health effects of fracking. In this observational study, the researchers applied extensive and rigorous methods to determine specific exposure-outcome associations between fracking and HF hospitalizations. Moving forward, we need to better understand the mediating effects by air and water pollutants, and the existence of racial disparities in the fracking impacts."

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Natural Gas, Vehicle Emissions, Air Pollutants, Water Pollutants, Benchmarking, Vibration, Pennsylvania, Stroke Volume, Air Pollution, Environmental Exposure, Noise, Water Pollution, Hospitalization, Heart Failure

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