September 17, 2014

LAS VEGAS, NV — An uptick in hospitalizations for heart-failure exacerbation may not seem surprising in the winter holiday season, but an observational study suggests that, at least at one center, those events are less common on Christmas and New Year's Day themselves than during the rest of December and January[1].

Also, the study suggests that the holiday phenomenon isn't limited to the winter and hints that it may also apply to days that aren't holidays but have a lot in common with them, such as prevalent overindulgence in food and drink. Hospitalizations for heart-failure exacerbation in the study, based on all 12 727 such cases over 11 years at one Philadelphia center, also went up in association with Independence Day (July 4) and Super Bowl Sunday, traditionally the first Sunday in February.

In fact, Dr Mahek Shah (Einstein Medical Center, Philadelphia, PA), lead author of the analysis, noted for heartwire , it was after Super Bowl Sunday in 2005—New England Patriots 24, Philadelphia Eagles 21—when his center saw the study's highest spike in heart-failure admissions.

In the study presented in poster form here at the Heart Failure Society of America (HFSA) 2014 Scientific Meeting , holiday-related spikes in HF admissions hit not on the actual day of the holiday, but during the following four days. And HF admission rates were consistently lower on the holiday itself than at other times of the same month.

Mean Heart-Failure Admissions/Day at Different Periods During Holiday Months

Holiday or Special Day The 4 Immediate Postholiday Days The Month, Excluding the 4 Postholiday Days The Holiday Itself
Independence Day 5.6 5.0a 3.8b
Thanksgiving 5.7 5.6 4.2b
Christmas 6.5 5.5a 3.6b
New Year's Day 6.5 6.3 5.1b
Super Bowl Sunday 7.0 6.2 5.5
a. p<0.05 vs the 4 immediate postholiday days
b. p<0.05 vs the month excluding the 4 postholiday days

That HF hospitalizations climbed after the July 4 holiday was a bit of a surprise. Few in the US are straining to shovel snow out of driveways then. But eating to excess, especially the kind of sodium-heavy foods and alcoholic drinks that stress the body's fluid and electrolyte balance, can be as much a part of July 4 celebrations as of Christmas gatherings and Super Bowl parties.

"This is a month when people [usually] don't come to the hospital as often as in the winter season. But the [holiday-heart] pattern still applied," he said. "You still see a spike in heart-failure exacerbations at holidays, be it any time of the year."

There could be many reasons that heart failure can worsen especially on the holidays and during other special events, according to Shah. Beyond the dietary pitfalls of such days, on holidays people may be inclined to misinterpret or underestimate the severity of any symptoms and not promptly seek medical attention. Unwillingness to let a hospital crisis interfere with festivities shared by relatives and friends may also play a role.

"If you think about it, people are not going to [want to] come in on Christmas, even if they have a few symptoms," Shah said. "If they feel bad, people just wait. They don't want to ruin the holiday for anyone else."

Shah had no disclosures.

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