Original ArticleChanges in atrial fibrillation admissions following daylight saving time transitions
Introduction
Daylight saving time (DST) was first adopted in the early twentieth century to preserve resources in the spring and summer months. It is now implemented in over 70 countries and affects over 1.5 billion people around the globe [1]. Transitions to and from DST are characterized by moving the clock 1 h ahead in the spring and back in the autumn. These clock changes are associated with sleep cycle derangements, disruptions in circadian rhythm, increases in sleep fragmentation and latency leading to cumulative effects during the week following DST transitions [2], [3], [4], [5]. These same periods have been linked to environmental dangers including increased traffic accidents and workplace injuries [4], [6]. Health consequences associated with these transitions include increased incidence of ischemic stroke and acute myocardial infarction (MI) [7], [8], [9], [10], [11], [12]. Based on the adverse impact of DST transitions, the European Union convened an international group of specialists in August 2018 who recommended DST should be discontinued and the European Parliament voted in March 2019 to abolish the practice by 2021 [5], [13].
Sleep disordered breathing and sleep disruptions are known risks for atrial fibrillation (AF) [14], [15], [16]. Since DST transitions impact sleep and cardiovascular events, we sought to examine a link between DST transitions and AF. We are not aware of a prior study examining DST transitions and AF. We hypothesize that sleep cycle disturbances associated with DST transitions increase incidence of AF episodes. To examine this hypothesis, we performed a retrospective cohort study to examine the relationship between DST transitions and AF admissions at a large academic tertiary care medical center.
Section snippets
Methods
All hospitalizations with primary ICD9 diagnosis of AF for calendar years 2009–2016 for patients aged 18–100 at our single center were reviewed. We included International Classification of Diseases (Ninth Revision) 427.31 (atrial fibrillation), I48.0 (paroxysmal atrial fibrillation), and I48.91 (unspecified atrial fibrillation). We excluded I48.2 (chronic atrial fibrillation) and I48.1 (persistent atrial fibrillation). Demographic and patient characteristic information was obtained. Race and
Results
We included 6089 individuals admitted for AF to our center; 134 and 112 admissions occurred in the seven days following the DST spring transition and the DST autumn transition, respectively. The mean age was 68 ± 15 years with females composing 53% of subjects. There were no statistically significant differences between those admitted in the weeks following DST transitions compared to the rest of the year (Table 1).
Over the eight years analyzed, the mean daily admission rates for AF were
Discussion
Our data add to growing evidence suggesting transitions to and from DST, specifically the spring transition into DST, is associated with negative health outcomes and in particular cardiovascular disease. To the best of our knowledge, our study is the first to demonstrate a relationship between DST transitions and AF. Specifically, our data show an increase in AF hospitalization rates in the period following the spring transition to DST. When stratified by gender, this finding is driven by AF
Limitations
This study has several limitations. First, it is a retrospective analysis of data from a single center. Second, hospitalization ICD9 codes were used, not a review of patient records with electrocardiogram to confirm the diagnosis. Although ICD9 codes for chronic AF were excluded, some may have been miscategorized. Additionally, these codes would not account for planned admissions for procedures such as cardioversion or ablation. Third, we did not differentiate between new onset AF versus those
Conclusion
An increase in AF hospital admissions was seen following the spring DST transition, particularly among women. This finding adds to a growing body of evidence of health risks associated with DST transitions and extrinsic factors that contribute towards AF episodes. Further investigation is warranted on a larger scale to further explore the AF following DST transitions and gender differences. Consideration of continuing DST in light of potential negative health consequences is warranted.
CRediT authorship contribution statement
Jay J. Chudow: Conceptualization, Methodology, Investigation, Data curation, Formal analysis, Writing - original draft, Project administration. Isaac Dreyfus: Writing - original draft, Writing - review & editing. Lynn Zaremski: Conceptualization, Writing - review & editing. Alon Y. Mazori: Formal analysis, Investigation, Data curation. John D. Fisher: Conceptualization, Writing - review & editing. Luigi Di Biase: Conceptualization, Writing - review & editing. Jorge Romero: Conceptualization,
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