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Nearly 25 years ago, the American Heart Association (AHA) and the American Stroke Association developed the Get With The Guidelines (GWTG) series1,2 to increase the consistent implementation of guidelines-based care in hospitals for patients with cardiovascular disease (CVD) and stroke.1-3
The GWTG suite of programs aims to improve patient care and outcomes through resources such as provider education, quality improvement measures, and patient registries, with an overarching goal of reducing death and disability associated with CVD and stroke.4,5
For updates on the current status and achievements of the GWTG series, Cardiology Advisor interviewed AHA volunteer Gregg Fonarow, MD, FAHA, interim chief of the division of cardiology and the Eliot Corday Chair in Cardiovascular Medicine and Science at the University of California, Los Angeles (UCLA). Dr Fonarow is also director of the Ahmanson-UCLA Cardiomyopathy Center and co-director of the UCLA Preventative Cardiology Program.
How did the GWTG series come about? Why was there a need to create such a program in the various areas of focus, such as stroke and atrial fibrillation?
Dr Fonarow: In 1999, AHA volunteers identified a need to establish a mechanism by which hospitals could stay up to date with the latest clinical guidelines and recommendations to improve cardiovascular care quality and clinical outcomes. The AHA had set an ambitious goal to reduce death and disability due to CVD by 25% by 2010.1 With that goal in mind, AHA created the very first GWTG module for coronary artery disease, beginning with a regional pilot program. Based on this initial success, GWTG expanded nationally in 2001 and then launched additional modules.6
"
All GWTG [Get With the Guidelines] modules are associated with significant improvements in multiple processes of care strongly linked to improved outcomes.
This performance-improvement, registry-based approach would allow sites to evaluate their patient population against the most recent guideline-directed medical therapies, engage in collaborative learning, and share best practices. In addition to the technical support for the effort, AHA introduced the role of Quality Improvement consultants. Every GWTG hospital is provided a skilled quality consultant to assist as they use the registry to report on performance, identify opportunities for process improvement, and support their facility accreditation and certification with data from the registry. Sites also have the opportunity to be recognized by the AHA for their consistent performance.
GWTG is now available for atrial fibrillation, coronary artery disease including chest pain, heart failure, stroke, and resuscitation to support cardiac arrest care.2
Since the program’s inception, what have been some of the most significant achievements in terms of improved processes and outcomes at participating hospitals?
Dr Fonarow: All GWTG modules are associated with significant improvements in multiple processes of care strongly linked to improved outcomes. The AHA’s 2010 Strategic Goal was able to be met 3 years early, in 2007, in part based on GWTG.6
Currently, more than 2,600 US hospitals participate in one or more GWTG program module. That means nearly 80% of the American population has access to the program. Plus, since the creation of the program, more than 13 million US patient records have been entered into the registry.2
A few of the most significant achievements include:
- Demonstrating that participation in GWTG could reduce and even eliminate race/ethnicity- and sex-based disparities in the use of guideline recommended therapies. Equitable care provision during hospitalization has been achieved for most of the achievement measures targeted in GWTG modules.7,3
- Learning that recognition, along with targeted quality improvement efforts, can drive adherence with the most recent clinical trial evidence and guidelines. An example was the development of the Target: Stroke program. The primary goal of this initiative was to reduce the door-to-needle times, as time to treatment is strongly associated with stroke outcomes. In just the first year of Target: Stroke, participating hospitals reduced the time from 80 minutes pre-intervention to 68 minutes, and patients experienced substantially improved clinical outcomes.8 In subsequent phases of the project, we have seen continued improvement and have now added Target: Stroke Advanced Therapy to evaluate and monitor interventional treatment.
- Integrating Target: Type 2 Diabetes in the Get With The Guidelines - Stroke, CAD, and HF modules, so we are caring across diagnoses.
- Targeted implementation of the April 2022 Heart Failure guidelines in a pilot program that utilized Get With The Guidelines – Heart Failure. The emphasis was on the provision of quadruple therapy, which has increased the provision of guideline-directed medical therapies with participating sites from 14% to 49%. More importantly, the impacted patients had improvement in their LVEF [left ventricular ejection fraction]– moving from 9% at baseline to 55%.9
- Emphasizing systems of care for ST elevation myocardial infarction (STEMI). The GWTG-Coronary Artery Disease module meets the needs to measure and improve care from first medical contact – ie EMS or referring hospital – to reperfusion at the receiving center. Cohorts (eg, regions, states, and health systems) can use a Get With The Guidelines – Super User account to create data reports that drive performance as a group.
What are the key factors driving the success of the GWTG programs?
Dr Fonarow: Understanding quality measurement is critical to improving patient care and making the certification process simple. Participating hospitals take their efforts a step further to ensure teams are using current guideline-directed treatments, setting best in class goals, and using peer benchmarks to compare performance. The integration of the most current guidelines is a key benefit to sites.
Each participating hospital and health system works with a program consultant to implement, interpret data, identify areas for improvement, and articulate recommendations internally. It’s like having a consultant for the organization’s quality improvement objectives – and a significant reason these programs are so successful.
Also, the GWTG registry tool collects data from participating hospitals, allowing health care leaders and researchers to examine trends and continue bringing current evidence-based guidance to care delivery at hospitals across the country.
What are examples of situations in which deviation from the guidelines may be necessary – for example, due to access issues, limited resources, or patient-specific scenarios?
Dr Fonarow: As with any therapy, there are contraindications to some treatments, and collecting information on contraindications is actually built into the registry. Sites are provided the opportunity to document the reason why a patient was excluded from the treatment and can use that information to evaluate overall treatment and considerations for process improvement. And of course, the final decision on treatment resides with the patient and their caregivers. They can decide against a treatment, and GWTG allows for that documentation.
What areas are targeted for further development, and what are some of the program goals for the future?
Dr Fonarow: Until recently, the biggest gap in reaching all hospitals pertained to the small or rural hospital. These sites were less likely to join the quality improvement program due to resource limitations and low volumes of patients. However, the data shows these residents are at 30% higher risk of stroke, 40% more likely to develop heart disease, and live an average of 3 years fewer than urban counterparts.10 Yet, when rural hospitals did participate in GWTG, care quality improved, and in many cases performance rivaled that of urban hospitals. The AHA has now launched the Rural Community Network, which is open to all rural hospitals to join GWTG. This program aims to help close those gaps. More than 350 new hospitals have signed up so far.
As newer therapies are discovered, tested, proven to provide patient-centered outcomes, and are integrated into the national guidelines, these therapies can be rapidly integrated into GWTG. The program aims to further enhance these processes, so that each patient receives the best evidence-based care at the right time, at the right dose, equitably, reliably, every time. This is aligned with the AHA’s goal of advancing cardiovascular health for all, including identifying and removing barriers to health care access and quality.
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April was Stress Awareness Month, the perfect excuse to get stress under control. Although cardiologists may recognize the undeniable link between stress and heart health, they’re far from immune to its harmful effects. Mindfulness is a promising way for physicians and patients to find relief.
Mindfulness is an ancient practice gaining steady traction in modern medicine. This cost-effective intervention improves quality of life and reduces health care costs and hospitalizations.1 In addition, mindfulness interventions don’t interfere with existing treatment plans but may enhance their efficacy.
Although mindfulness can be packaged into different formats (meditation, yoga, or as part of cognitive behavioral therapy), the basic principle involves actively focusing on the present to relax the body and mind.
The time has come for overstressed physicians to teach by example through practicing mindfulness. If you’re still not convinced, here’s the evidence.
Taking control of the heart-mind connection
The relationship between stress and cardiovascular health is complex. When the body perceives a threat or experiences stress, it triggers a cascade of physiological responses, including the release of stress hormones such as cortisol and epinephrine. These hormones spike heart rates, raise blood pressure, elevate blood sugar, and boost inflammation.
Chronic stress, characterized by persistent activation of the body's stress responses, can assault the cardiovascular system over time. Research has established a clear link between chronic stress and an increased risk for hypertension, heart disease, and stroke. Moreover, stress worsens existing cardiovascular conditions, making management and treatment more challenging.
The impact of stress on heart health is well-established. Although mindfulness has become a popular buzzword in health and wellness spaces, it’s not necessarily a common practice. Fortunately, basic mindfulness exercises can be done anywhere, anytime. All you need is a few minutes in a quiet space.
To practice mindful meditation, follow these steps:
- Sit down, close your eyes, and practice deep, slow breathing.
- Consciously relax each muscle group, starting with the lower body.
- As you work your way up, shrug your shoulders and roll your head in different directions.
- Choose a calming word and say it quietly with each exhalation, like “peace.”
- Continue for 5 to 10 minutes. As your thoughts wander, refocus back on meditating.2
Group mindfulness programs can increase accountability for regular practice. Making a conscious effort to focus on the present and clear your mind can turn almost any steady-state activity into a mindfulness exercise, including walking, swimming, and bike riding.2 Participating in mind-body activities helps harness the benefits of mindfulness while providing the added benefit of some physical exercise, through tai chi and yoga, for example.
Is mindfulness worth it?
While most physicians agree that their patients would benefit from mindfulness practices, carving out time for mindfulness isn’t always a priority for doctors themselves. Knowing in real numbers how mindfulness can impact health helps build a case for it.
Numerous studies have demonstrated that calming the mind calms the body. A 2013 review of 9 studies published in the AHA journal Hypertension found meditation reduces systolic blood pressure by 4.7 mm Hg and diastolic by 3.2 mm Hg.2 In another study, 5 minutes of daily meditation positively affected heart rate variability. This measure of heart attack and stroke in those without cardiovascular disease showed improvements within just 10 days of consistent meditation practice.2
In another meta-analysis, which included 16 studies and 1,476 adults, mindfulness-based interventions significantly improved psychological distress, enhancing self-awareness, attention, and emotional regulation.3 This review observed more drastic impacts on blood pressure, with an average 14 mm Hg reduction in systolic and a 5 mm Hg decrease in diastolic readings for participants in mindfulness-based intervention versus control groups.
Most recently, a 2024 meta-analysis of 12 randomized controlled trials confirmed that structured mindfulness-based intervention programs effectively reduce blood pressure in participants with prehypertension and hypertension.4 These benefits were more pronounced in men. The researchers noted, “In addition, the results also support previous studies which showed that MBIs [mindfulness-based interventions] can lower blood pressure in patients with other diseases, such as breast cancer survivors, coronary heart disease, and diabetic patients.”
By promoting relaxation responses, mindfulness modulates stress hormone levels, counteracting the harmful physical effects of chronic stress. It targets emotional distress, helping prevent disease and slow disease progression.
In a systematic review of mindfulness interventions for patients with heart failure, researchers concluded that practicing mindfulness is “beneficial for patients with heart failure in reducing depression and anxiety and enhancing health-related quality of life in the short term.”1 Some studies noted improvements in physical symptoms like fatigue, unsteadiness, dizziness, and breathlessness. In 1 of the studies reviewed, researchers observed sustained positive effects on depression and anxiety lasting 3 months and 6 months after the completion of mindfulness programs.
Although the long-term effects aren’t always documented in studies, there’s no downside to practicing mindfulness, and the potential for ongoing benefits makes developing a mindfulness habit worthwhile.
Why cardiologists need mindfulness
Physicians, as caregivers entrusted with the health and well-being of others, often find themselves navigating high-pressure environments fraught with stressors. From demanding workloads and long hours to the emotional toll of patient care, the medical profession is inherently predisposed to stress and burnout.
Studies show physician burnout is at an all-time high, and cardiologists are no exception. One survey of almost 6,000 cardiologists found that 42% of cardiologists feel burned out, and 83% have symptoms of colloquial depression.5 While 16.9% of cardiologists surveyed reported having a mental illness, only 34.2% attempted to get help. The top cited barriers stopping cardiologists from seeking mental health support included privacy concerns (34.5%), time constraints (30.8%), shame (29.5%), and fears about how it would impact their professional advancement (28.6%).
Although mindfulness isn’t a sufficient replacement for mental health treatment, it’s a practical option with the potential to improve cardiologists’ everyday lives. By integrating mindfulness practices into their daily routines, physicians can develop a greater self-awareness, emotional regulation, and compassion for patients.
Prioritizing self-care and stress management sets a positive example for patients and colleagues, reinforcing the importance of holistic health practices. Cardiologists can lead the way in championing initiatives that promote a culture of well-being and mindfulness among others.
Stress Awareness Month isn’t just for patients. Cardiologists can harness the power of mindfulness and other stress management strategies to improve their lives. By learning and doing mindful meditation, cardiologists promote the highest level of heart health care for themselves and others.
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Caffeinated energy drinks sold at popular chain restaurants have become the focus of increasing attention recently since wrongful death lawsuits were filed attributing 2 cardiac-related deaths to the consumption of Charged Lemonade from Panera Bread: In September 2022, a 21-year-old woman with long QT syndrome (LQTS) died from cardiac arrhythmia due to LQTS after consuming an unspecified amount of the drink, and a 46-year-old man died in October 2023 from cardiac arrest due to hypertensive disease after drinking 3 cups of the beverage.1,2
The lawsuits filed by the families of these individuals allege that the caffeine content of the drinks was not properly advertised and that consumers were not warned about the associated risks.3
Cardiovascular Effects of Energy Drinks
Paul Leis, DO, assistant professor of medicine in the division of cardiology at the Icahn School of Medicine at Mount Sinai in New York, believes that many cardiologists are aware that highly caffeinated energy drinks are on the market but may be “unaware of how much caffeine they contain and whether they exceed the recommended daily limit of 400 mg as outlined by the FDA,” he said.4 “Also, some patients may have multiple of these drinks per day, which can be harmful.”
"
Providers other than cardiologists should be educated and informed of the risks associated with these drinks as well, as they may also be involved in the care of at-risk individuals.
Various studies have linked the consumption of energy drinks to a wide range of cardiovascular side effects, including increased blood pressure, cardiac arrhythmias, prolonged QT interval, cardiac arrest, coronary disease, heart failure, and aortic dissection.5
According to Helga Van Herle, MD, cardiologist and associate professor of clinical medicine with Keck Medicine of the University of Southern California in Los Angeles, the consumption of drinks with high caffeine content can be especially risky for individuals with pre-existing cardiac conditions such as rhythm disturbances, as well as those with caffeine sensitivity and those taking medications with the potential to cause side effects such a heart palpitations or tachycardia. “For example, prescription stimulants or stimulant-like medications for conditions including ADHD, narcolepsy, and other sleep-related issues commonly have palpitations or tachycardia as a side effect, and high levels of caffeine intake have the potential to exacerbate these symptoms.”
Although the caffeine content of beverages can vary substantially depending on a range of factors, the approximate amount of caffeine found in commonly consumed drinks are as follows:
- 80 to 100 mg in an 8-ounce cup of coffee
- 40 to 250 mg in an 8-ounce energy drink
- 30 to 50 mg in an 8-ounce cup of green or black tea
- 30 to 40 mg in a 12-ounce caffeinated soft drink4
The large Charged Lemonade from Panera Bread contains approximately 390 mg of caffeine, and the large size of the recently launched Sparkd’ Energy drink from Dunkin’ contains an estimated 192 mg of caffeine.6,7
“I think issues arise when someone significantly exceeds the recommended limit, typically as an acute ingestion rather than habitual use, as with most coffee drinkers,” said Catherine Benziger, MD, MPH, director of research at Essentia Health Heart and Vascular Center in Duluth, Minnesota, and member of the American College of Cardiology’s Prevention of Cardiovascular Disease Council. “Drinking 2 or more high-energy caffeinated drinks can put the consumer well over the daily recommended caffeine limit and at risk for heart-related events.”
Dr Van Herle noted that, along with caffeine, energy drinks often contain other substances intended to increase energy, such as guarana, ginseng, and ephedra, which may have proarrhythmic effects.8
Clinical Recommendations
In general, Dr Benziger recommends that patients not exceed the recommended limit of under 400 mg of caffeine per day. This would equate to “approximately 4 cups of coffee, and the caffeinated drinks at Panera and Dunkin’ would also fall within this range but only if you drink just one,” she said. She pointed out that other products also contain various amounts of caffeine, such as ice cream, chocolate, foods containing coffee, and caffeine pills. While many of these products can typically be safely consumed within reasonable limits, using them “in combination can greatly exceed the recommended daily limit and put people at risk for a variety of heart issues such as increased heart rate, increase blood pressure and abnormal heart rhythms, such as supraventricular tachycardia.”
Dr Leis recommends that patients with known cardiac disease, especially arrhythmias, avoid consuming energy drinks to reduce the risk of associated complications. “In particular, for arrhythmias such as atrial fibrillation, the high caffeine content from these drinks could potentially put patients who have rate-controlled atrial fibrillation into an uncontrolled ventricular rate and lead to potential complications,” he explained.8
Additionally, patients with hypertension who consume high amounts of caffeine can experience increased blood pressure due to adrenergic stimulation, he said. “For those who have had a myocardial infarction or have established coronary artery disease, increased heart rate and blood pressure resulting from these energy drinks could potentially cause symptomatic angina from the increased demand on the heart.”
In addition, Dr Benziger noted that people may use caffeine to compensate for inadequate sleep, and depending on the individual, may benefit from improved sleep habits including earlier bedtimes and less screen time in the evening so they can reduce their reliance on caffeine. For other patients, undiagnosed sleep apnea may be causing excessive tiredness.
“We know poor sleep is associated with cardiovascular disease and heart attacks, and the American Heart Association Life's Essential 8 recommends 7 to 9 hours of sleep per night for adults,” she said.9 “If people are using caffeine because they are often tired and not getting good-quality sleep, I recommend they talk to a doctor about it.”
Public Health Measures Needed
Along with steps that consumers can take to reduce caffeine intake, several safety measures are needed on the public health level as well. “We need to have full transparency on the caffeine content of energy drinks so people will know how much caffeine they are getting and whether they are over the recommended level,” Dr Leis stated. Currently, the FDA does not regulate energy drinks and does not require sellers to list the caffeine content of beverages.10,11
"Another thing I would really like to see is some sort of warning label that perhaps certain populations should avoid these drinks, including but not limited to those with known cardiac conditions and those who are pregnant or breastfeeding—if we start off with at least those 2 groups, I think we would be headed in the right direction,” he suggested.
Dr Van Herle also points to the need for labels listing the other energy-boosting ingredients contained in these drinks to allow patients to make more informed decisions.
Transparency about ingredients and caffeine levels of energy drinks is “particularly important for children, who are often attracted to these drinks because they're popular or their friends are using them or they are for sale at their schools,” Dr Benziger emphasized. She cautioned that young children are especially susceptible to the effects of caffeine and said pediatricians advise that children under 12 years avoid caffeine consumption, that all children and teens avoid the consumption of energy drinks, and that those ages 12 to 18 years limit caffeine intake to 100 mg at most.12
“Providers other than cardiologists should be educated and informed of the risks associated with these drinks as well, as they may also be involved in the care of at-risk individuals,” Dr Van Herle added.
Future Research
Numerous questions warrant attention in future research regarding highly caffeinated beverages. According to Dr Van Herle, “There are several things health providers need to better understand, including how highly caffeinated beverages affect individuals with specific cardiac conditions—especially those at risk for lethal arrhythmias; how these beverages interact with prescription medications that can potentiate an individual’s risk of a heart arrhythmia; and whether individuals in different age groups are more or less at risk of cardiac issues that may stem from consumption of these drinks, especially since much of the marketing is geared towards a younger age group.”13
Dr Leis would like to see research examining the incidence of arrhythmias among individuals with daily consumption of highly caffeinated energy drinks to gauge whether rates are higher in this group compared to individuals with less frequent consumption. Such data could inform recommendations regarding the risk of developing arrhythmias among individuals who frequently consume these beverages.
There is an ongoing need for further research regarding safe levels of caffeine intake and which populations are at risk for acute caffeine toxicity, Dr Benziger stated. She also cited an urgent need for data on the use of energy drinks among adolescents, as nearly one-third of those aged 12 to 17 years reportedly consume these products on a regular basis.14 “This is not my area of expertise as I'm an adult cardiologist, but I think that any behavior that starts in adolescence may track into adulthood and could lead to chronic diseases or poor health habits in the future.”
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Consistent evidence supports a link between exposure to wildfire smoke and increased pulmonary morbidity, with multiple studies showing associations between levels of particulate matter 2.5 (PM2.5) from wildfires and rates of hospitalization and emergency department (ED) visits for respiratory illnesses such as acute bronchitis, asthma, and chronic obstructive pulmonary disease.1-3 Additionally, some studies have demonstrated associations between exposure to wildfire smoke and an increased risk for cardiovascular disease (CVD).
“Emerging data suggests that wildfire smoke exposure increases cardiovascular events such as heart attacks and cardiovascular hospitalizations, and elderly patients and patients with underlying comorbidities such as cardiovascular disease and respiratory conditions seem to be more susceptible,” explained American Heart Association (AHA) volunteer Sanjay Rajagopalan, MD, FACC, FAHA, chief of cardiovascular medicine and chief academic and scientific officer at University Hospitals Harrington Heart and Vascular Institute in Cleveland, Ohio. “The chemical composition of wildfire smoke suggests that it may be even more toxic than traditional fossil fuel-based emissions.”4
Findings on Wildfire Smoke and CVD Risk
In a study published in 2022 in Geohealth, stratified analyses showed an increase in unscheduled hospital visits in California for all CVDs, ischemic heart disease, and heart failure among non‐Hispanic White patients and patients older than 65 years on days with the highest concentrations of PM2.5 from wildfires. The study authors also reported that higher temperatures may interact with wildfire-derived PM2.5 and further increase hospital visits for CVD among individuals with pre-existing heart disease.1
Another California-based study observed higher rates of ED visits for various CV events, including myocardial infarction (RR, 1.42; 95% CI, 1.09-1.84), ischemic heart disease (RR, 1.22; 95% CI, 1.01-1.47), and heart failure (RR, 1.22; 95% CI, 1.10-1.35) on days with dense smoke, with the highest rates found among adults aged 65 years and older.5
In other studies, the risk for out‐of‐hospital cardiac arrest increased on days with heavy smoke due to California wildfires, and elevated levels of PM2.5 from Colorado wildfires were associated with increased rates of CVD hospitalization and CV mortality (OR, 1.478; 95% CI, 1.12–1.94).6,2
In a study published in 2022, post-wildfire physician visits among older adults increased by 11% (95% CI, 3%-21%) for congestive heart failure and 19% (95% CI, 7%-33%) for ischemic heart disease, and patients with diabetes demonstrated a higher risk for CV morbidity (relative risk [RR], 1.22; 95% CI, 1.01-1.46) and respiratory morbidity (RR , 1.35; 95% CI, 1.09-1.67) following wildfires in Calgary, Canada.7
Other recent research suggests a slight increase in the risk of CV mortality associated with wildfire smoke, with 2 studies showing that 0.55 and 0.56 of CV deaths were attributable to wildfire-related PM2.5 exposure during each study period.8,9
Overall, however, findings regarding the connection between wildfire smoke and CV outcomes are mixed.2 “While some studies have indicated an uptick in emergency room admissions for CVD post-wildfire, others have not,” noted Julio Lamprea Montealegre, MD, PhD, MPH, clinical instructor in the division of cardiology at the University of California San Francisco. “The specific types of cardiovascular events that are most likely affected by wildfire exposure also remain unclear.”
Clinical Implications and Next Steps
Although further research is needed to elucidate the relationship between CVD and wildfire smoke exposure, wildfire-related CV events may become more prevalent with the potential intensification of wildfires in the coming years, according to Dr Rajagopalan and Dr Montealegre. This possibility highlights the need for increased awareness and preparation among patients, providers, and health systems.
“Awareness is the first prerequisite for appropriate intervention, and the association between cardiovascular events and wildfire smoke needs to be widely promulgated amongst health care personnel,” Dr Rajagopalan said. Patient awareness of neighborhood air pollution levels during wildfire episodes is also important. Higher-risk patients, such as the elderly and those with prior CV or respiratory conditions, should be educated about protective measures, he advised.
“The US Environmental Protection Agency (EPA) has set forth recommendations to mitigate exposure to particle pollution, particularly for vulnerable groups including those with pre-existing cardiovascular diseases,” Dr Montealegre stated. “Recommendations encompass both indoor and outdoor measures, such as employing portable air cleaners and limiting outdoor activities during times when the Air Quality Index (AQI) indicates unhealthy levels.”10 Patients and providers can check AirNow.gov to monitor daily AQI forecasts.
As roughly 67% of exposure to PM2.5 from outdoor origins occurs inside the home due to infiltration of outdoor pollutants, efforts to improve indoor air quality are essential in reducing wildfire smoke exposure and related health risks.11
In a review published in 2022 in Circulation, Hadley et al recommended various measures to reduce wildfire smoke exposure and the associated CV impact in affected areas.12 On the individual level, for example, they recommend the use of particle respirators such as N95 masks among vulnerable patients.12
In the health care setting, they recommend that clinicians ensure the aggressive management of traditional CVD risk factors and optimization of medical therapy among at-risk patients prior to the start of each fire season.12
More broadly, they recommend that health care facilities strive for cleaner indoor air and that health systems “make preparations for wildfire season to protect their susceptible patients and avoid shortfalls in beds, supplies, human resources, and key partnerships,” as described in the paper.12
Dr Montealegre emphasized the crucial need for a deeper dive into research aimed at elucidating the CV consequences of wildfire smoke. “Priorities include enhanced exposure science that offers a precise evaluation of individual exposure levels, rigorous mechanistic studies elucidating the connection between pollutants from wildfire smoke and cardiovascular repercussions, and clinical trials assessing the efficacy of mitigation techniques such as air filters in curtailing cardiovascular events,” he said.
Beyond efforts to mitigate the adverse health effects of wildfire smoke in high-risk individuals, the most important broader measures needed in this area are “steps to prevent climate change, which include ongoing efforts at decarbonizing our economy and uncoupling CO2 emissions from economic activity,” Dr Rajagopalan stated. “In this regard, movement to a fossil fuel-free future is not only eminently possible, but may also be associated with better health, better economies, and hopefully better climate in the not-too-distant future.”
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