Job exposures may raise AF risk for firefighters
Firefighters who reported responding to at least 31 fires per year were more than twice as likely to have a diagnosis of atrial fibrillation compared with those who responded to five or fewer fires per year, survey data show.
Exposure to inhaled smoke, pollutants, volatile organic compounds and polycyclic aromatic hydrocarbons in the firefighting environment has been associated with detrimental respiratory and CV effects, making firefighters a unique population with personal and occupational risk factors for CVD, Paari Dominic, MD, associate professor of medicine and molecular and cellular physiology and director of clinical cardiac electrophysiology at Ochsner-Louisiana State University Health Shreveport, and colleagues wrote in the Journal of the American Heart Association.
“Firefighters may be a unique, high-risk population with regards to developing atrial fibrillation at a younger age based on the number of fires they fight per year,” Dominic told Healio. “The assessment of the risk for AF in an individual patient may have to extend beyond traditional risk factors, especially among firefighters, and will have to include occupational risks. For example, palpitations, a common symptom of AF, should be approached differently in a firefighter aged at least 60 years who has fought 30 to 40 fires per year, with other traditional risk factors like hypertension and sleep apnea compared with similarly aged non-firefighter with the same symptoms and same risk factors.”
Survey data
In a cross-sectional study, Dominic and colleagues analyzed survey data from 10,860 active firefighters, of whom 93.5% were men and 95.5% were aged 60 years or younger. Firefighters who were members of at least one of five preselected professional organizations were surveyed via electronic links distributed by the organizations. The survey queried the number of fires fought per year as a measure of occupational exposure, as well as self-reported CVD. Respondents completed the surveys from October 2018 to December 2019.
Within the cohort, 89% identified as career (paid) firefighters, with 15.4% reporting prior military experience and 77.3% serving at the local level. Self-reported CVD included AF (2.7%), MI (1.7%), CAD (4.2%), peripheral artery disease (0.5%) and stroke (0.8%). Researchers found that firefighters who fought a higher number of fires per year had a higher prevalence of AF.
Among respondents, 4.5% of those who fought at last 31 fires per year had AF, compared with 3% of those who fought between 21 and 30 fires per year, 2.7% of those who fought 11 to 20 fires per year, 2.3% of those who fought six to 10 fires per year and 2% of those who fought fewer than five fires per year (P < .001).
Link between fires fought, incident AF
In regression analyses, researchers found the number of fires fought per year was associated with increased risk for AF (OR = 1.14; 95% CI, 1.04-1.25; P = .006).
Researchers also found that prevalence of AF increased with age, with firefighters aged at least 61 years reporting a higher incidence vs. those aged 60 years or younger (8.2% vs. 2.5%; P < .001). Governmental level of employment, type of employment (career, volunteer or paid per call) and presence of prior military service had no effect on the prevalence of AF.
“The results of this study need to be validated with a prospective cohort and more rigorous cardiac rhythm monitoring,” Dominic told Healio. “Second, the pathophysiology of this heightened risk needs to be further explored, specifically the role of particulate matter exposure and adrenergic stress. Another avenue for research is the optimal treatment of AF in firefighters considering their occupational lifestyle and hazards, such as the use of anticoagulation in firefighters who are at high risk of physical injuries.”
As Healio previously reported, CVD events are the leading cause of duty-related events in the fire service. Research published in July in Obesity showed firefighters who have a higher BMI and are older are more likely to have a higher prevalence of CVD risk factors.
For more information:
Paari Dominic, MD, can be reached at paari.dominic@lsuhsc.edu; Twitter: @drpaari.
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