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Peer-reviewedCC BY-NC-NDJAMA Network Open

Ambient Temperature and Heart Failure Hospitalizations in Older Adults in the US

  • Nathaniel Kuhrt1,2
  • Ashwaghosha Parthasarathi3,4
  • Daniel I. Bisno5,6
  • Kevin Josey7
  • Poonam Gandhi3,4
  • Melanie Rua3,4
  • David Robinson8
  • Emily Wo9
  • Aayush Visaria3,4,10
  • Lizbeth Gomez3
  • Ehimare Akhabue11
  • Maya Guglin12
1 more authors
  • Soko Setoguchi3,4,10
12 affiliations
  1. 1Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
  2. 2Rutgers New Jersey Medical School, Newark
  3. 3Rutgers RWJBarnabas Center for Climate, Health, and Healthcare, New Brunswick, New Jersey
  4. 4Center for Pharmacoepidemiology and Treatment Science, Rutgers Institute for Health, Health Care Policy, and Aging Research, New Brunswick, New Jersey
  5. 5Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
  6. 6Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University, Stanford, California
  7. 7Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora
  8. 8Department of Geography, Rutgers, The State University of New Jersey, New Brunswick
  9. 9Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
  10. 10Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
  11. 11Department of Cardiology, Northwell, New Hyde Park, New York
  12. 12Department of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Abstract

Importance: The U-shaped association between ambient temperature and cardiovascular mortality is well established. However, limited knowledge exists about the association between ambient temperature and heart failure (HF) hospitalizations, particularly among older adults in the US. Understanding this association is essential to informing climate adaptation strategies and health policies.

Objective: To assess the association between daily ambient temperature exposure and HF hospitalization among Medicare beneficiaries both nationally and by climate region.

Design, Setting, and Participants: This time-stratified case-crossover study included older adults (aged ≥65 years) hospitalized for HF between January 1, 2007, and December 31, 2022, based on Medicare claims data. Cases were defined as emergency department visits leading to HF hospitalization with up to 4 controls, or nonevent days, matched for the same patient on day of week, month, and year. The data analysis was performed between June 2025 and August 2026.

Exposure: Daily mean ambient temperature derived from the Parameter-Elevation Relationships on Independent Slopes Model linked through residential zip code.

Main Outcomes and Measures: The association between mean temperature exposure and HF hospitalization was estimated nationally and by 9 climate regions (Central, East North Central, Northeast, Northwest, South, Southeast, Southwest, West, West North Central) using conditional logit for distributed lag nonlinear models (reference, 75 °F). A 14-day lag was used for mean temperatures less than 75 °F and 0-day lag for mean temperatures greater than 75 °F.

Results: A total of 1 517 756 HF hospitalizations from 996 312 patients (mean [SD] age, 78.0 [8.2] years, 60.3% female) were identified. Colder ambient temperatures were associated with increased HF hospitalizations nationally. At the regional fifth percentile temperature compared with 75 °F, the largest associations were observed in the West North Central (n = 17 286 [1.1%]; odds ratio [OR], 1.62; 95% CI, 1.25-2.11), West (n = 107 911 [7.1%]; OR, 1.40; 95% CI, 1.28-1.53), Southwest (n = 30 536 [2.0%]; OR, 1.34; 95% CI, 1.11-1.62), and Northwest (n = 33 353 [2.2%]; OR, 1.34; 95% CI, 1.08-1.65) regions. Temperatures greater than 75 °F were not associated with increased HF hospitalization.

Conclusions and Relevance: This study found that among Medicare beneficiaries, colder ambient temperatures were associated with increased HF hospitalizations, whereas warmer temperatures were not. The U-shaped temperature-cardiovascular risk association described for cardiovascular mortality and other cardiovascular outcomes did not apply for HF hospitalizations among older adults in the US. These findings suggest that ongoing region-specific surveillance of heat- and cold-related HF hospitalization risk will be essential, particularly in areas with limited adaptive capacity.

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Cite

BibTeXRIS
BibTeX
@article{kuhrt2026ambient,
  title = {{Ambient Temperature and Heart Failure Hospitalizations in Older Adults in the US}},
  author = {Nathaniel Kuhrt and Ashwaghosha Parthasarathi and Daniel I. Bisno and Kevin Josey and Poonam Gandhi and Melanie Rua and David Robinson and Emily Wo and Aayush Visaria and Lizbeth Gomez and Ehimare Akhabue and Maya Guglin and Soko Setoguchi},
  journal = {JAMA Network Open},
  year = {2026},
  month = oct,
  doi = {10.1001/jamanetworkopen.2026.41051},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855944},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Ambient Temperature and Heart Failure Hospitalizations in Older Adults in the US
AU  - Nathaniel Kuhrt
AU  - Ashwaghosha Parthasarathi
AU  - Daniel I. Bisno
AU  - Kevin Josey
AU  - Poonam Gandhi
AU  - Melanie Rua
AU  - David Robinson
AU  - Emily Wo
AU  - Aayush Visaria
AU  - Lizbeth Gomez
AU  - Ehimare Akhabue
AU  - Maya Guglin
AU  - Soko Setoguchi
PY  - 2026
DA  - 2026/10/01
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.41051
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855944
AB  - Importance: The U-shaped association between ambient temperature and cardiovascular mortality is well established. However, limited knowledge exists about the association between ambient temperature and heart failure (HF) hospitalizations, particularly among older adults in the US. Understanding this association is essential to informing climate adaptation strategies and health policies.  Objective: To assess the association between daily ambient temperature exposure and HF hospitalization among Medicare beneficiaries both nationally and by climate region.  Design, Setting, and Participants: This time-stratified case-crossover study included older adults (aged ≥65 years) hospitalized for HF between January 1, 2007, and December 31, 2022, based on Medicare claims data. Cases were defined as emergency department visits leading to HF hospitalization with up to 4 controls, or nonevent days, matched for the same patient on day of week, month, and year. The data analysis was performed between June 2025 and August 2026.  Exposure: Daily mean ambient temperature derived from the Parameter-Elevation Relationships on Independent Slopes Model linked through residential zip code.  Main Outcomes and Measures: The association between mean temperature exposure and HF hospitalization was estimated nationally and by 9 climate regions (Central, East North Central, Northeast, Northwest, South, Southeast, Southwest, West, West North Central) using conditional logit for distributed lag nonlinear models (reference, 75 °F). A 14-day lag was used for mean temperatures less than 75 °F and 0-day lag for mean temperatures greater than 75 °F.  Results: A total of 1 517 756 HF hospitalizations from 996 312 patients (mean [SD] age, 78.0 [8.2] years, 60.3% female) were identified. Colder ambient temperatures were associated with increased HF hospitalizations nationally. At the regional fifth percentile temperature compared with 75 °F, the largest associations were observed in the West North Central (n = 17 286 [1.1%]; odds ratio [OR], 1.62; 95% CI, 1.25-2.11), West (n = 107 911 [7.1%]; OR, 1.40; 95% CI, 1.28-1.53), Southwest (n = 30 536 [2.0%]; OR, 1.34; 95% CI, 1.11-1.62), and Northwest (n = 33 353 [2.2%]; OR, 1.34; 95% CI, 1.08-1.65) regions. Temperatures greater than 75 °F were not associated with increased HF hospitalization.  Conclusions and Relevance: This study found that among Medicare beneficiaries, colder ambient temperatures were associated with increased HF hospitalizations, whereas warmer temperatures were not. The U-shaped temperature-cardiovascular risk association described for cardiovascular mortality and other cardiovascular outcomes did not apply for HF hospitalizations among older adults in the US. These findings suggest that ongoing region-specific surveillance of heat- and cold-related HF hospitalization risk will be essential, particularly in areas with limited adaptive capacity.
SN  - 2574-3805
ER  -