Extreme heat events and congestive heart… (F32ES038758) – Project Grant to The University Of Texas…

Abstract: Heat waves cause a disproportionate number of deaths relative to any other extreme weather event. Most of the hospitalizations and deaths during such extreme heat conditions are due to cardiovascular complications linked to elevated thermal strain, and not directly due to hyperthermia per-SE. As such, individuals with an already compromised cardiovascular system (e.g., congestive heart failure (CHF) patients) are at greater risk for morbidity and mortality during extreme heat events. However, relatively little is known regarding the consequences of CHF on thermal and cardiovascular responses during environmental heat exposure. Further, indoor cooling with an air conditioner remains the most effective strategy to prevent the deleterious health effects of extreme heat events. However, approximately 1 in 8 americans do not have in-home air conditioners, while power outages threaten region-wide access to air conditioning at times when IT is most needed. Thus, there is a clear need to identify non-air conditioning dependent cooling modalities to attenuate excessive elevations in core temperature and associated cardiovascular stress in patients with CHF during heat wave-like conditions. The broad goals of this project are to (1) characterize the adverse thermal and cardiovascular responses during extreme heat exposure in CHF and (2) test the efficacy of low-energy cooling strategies to mitigate those consequences. Aim 1 will test the hypothesis that skin and core temperatures, and the accompanying cardiovascular responses, to extreme heat exposure will be greater in individuals with CHF. Aim 2 will test the hypothesis that enhanced evaporative (via skin wetting with water spray) and convective (via cool water forearm & hand immersion) cooling will separately attenuate elevations in thermal and cardiovascular stress during the aforementioned extreme heat exposure in CHF. The expected outcomes from this work will have a direct positive impact on CHF patients through a greater understanding of the effects of CHF on physiological responses to environmental heat stress and through the evaluation of the efficacy of practical, low-energy, cooling strategies that have the potential to save lives during such conditions. This research directly supports the mission of NIH in that we will uncover mechanistic physiological findings from human participants with the goal of translating these findings to guide individuals, caregivers, and communities on effective approaches to reduce heat related illness/injury. To ensure that this study maximizes clinical relevance and my scientific training, i assembled a strong interdisciplinary clinical research/mentoring team consisting of expert integrative physiologists, physician-scientists, and a biostatistician. My primary goals during this fellowship are to complete the proposed project, gain valuable experience in conducting physiological studies in clinical patients (e.g., CHF), master several technical skills (e.g., cardiac echocardiography, biochemical analyses of cardiac strain, etc.), improve my ability to obtain future extramural research funding, and publish research findings in peer-reviewed medical and physiology journals, all directed to facilitate my transition to an independent clinical researcher.

Extreme heat events and congestive heart failure: reducing thermal and cardiovascular consequences

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