For older adults hospitalized for heart failure, returning to polluted air may slow their recovery. That’s one conclusion of a new study published in February in The Journals of Gerontology: Series A highlighting how environmental conditions—specifically airborne pollution—may affect health outcomes long after a patient leaves the hospital.
“Air pollution may represent a missed opportunity for improving risk stratification in heart failure care delivery,” said the study’s senior author Chixiang Chen, an associate professor in the Department of Epidemiology and Public Health at the University of Maryland School of Medicine (UMSOM) with a joint appointment in the University of Maryland Institute for Health Computing (UM-IHC).
Heart failure remains one of the most common causes of hospitalization among older Americans. While clinical care during and immediately after a hospital stay is well studied, data are limited on how the environmental conditions where people live affect healing in the weeks and months that follow.
To help fill this knowledge gap, a research team led by Chen analyzed data from 67,000 U.S. Medicare fee-for-service beneficiaries aged 65 and older—randomly selected from a data set maintained by the School of Pharmacy at UMSOM representing about 20 percent of national Medicare users—who were hospitalized for heart failure between 2017 and 2019. The team linked patients’ recovery outcomes to estimates of exposure to fine particulate air pollution known as PM2.5, tiny airborne particles produced by sources such as vehicle emissions, industrial activity and wildfires. These particles are small enough to penetrate deep into the lungs and contribute to systemic inflammation; both short- and long-term exposure to PM2.5 have been widely associated with risk of cardiovascular disease.
The results showed that older adults exposed to the highest levels of PM2.5 prior to heart failure—above about 8.6 micrograms per cubic meter—spent significantly fewer days at home in the 180 days after discharge than those living in low-pollution areas. Among patients with poorer recovery trajectories, those in the highest-pollution areas spent roughly five fewer days at home during the follow-up period. Exposure to higher air pollution was also associated with a modest but statistically significant increase in mortality risk within 180 days of discharge.
“Heart failure recovery doesn’t end when a patient leaves the hospital,” said study co-author Tong Wen, a postdoctoral fellow in the Department of Epidemiology and Public Health at UMSOM. “Our findings suggest that a patient’s residential environment, particularly the air they breathe, may play an important role in shaping recovery.”
Interestingly, the negative effects of air pollution were not evenly distributed. The association was strongest among patients already experiencing the most difficult recoveries, suggesting that air pollution disproportionately affects the most medically vulnerable individuals.
These findings support growing evidence that environmental factors play a meaningful role in cardiovascular health, particularly among older people. For patients recovering from heart failure—already a hit to physiological resilience—breathing polluted air prior to hospitalization may worsen underlying cardiopulmonary inflammation and reduce physiologic reserve. As a result, these patients may experience more difficulty recovering after discharge, leading to poorer post-discharge recovery trajectories.
The study underscores the potential value in assessing environmental exposures, in addition to clinical factors, in risk stratification in post-hospital care planning. Public health interventions, such as improving air quality, issuing targeted pollution advisories and providing extra support for high-risk patients living in more polluted areas, could help improve recovery outcomes.
As the population ages and heart failure remains a leading cause of hospitalizations, these data suggest that improving environmental conditions may be a worthy, if often overlooked, part of promoting better cardiovascular recovery and, more generally, healthy aging.
A follow-up study, currently under peer review, asks whether the relationship between different chemical components of PM2.5 and recovery after heart failure hospitalization differs across U.S. regions, potentially helping explain geographic variation in patient outcomes and inform more targeted air quality interventions.
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Rozalina McCoy, director of UM-IHC’s Center for Population Health and an associate professor of medicine in the University of Maryland School of Medicine, and Shuo Chen, an MPower Professor of Biostatistics and Bioinformatics in the Department of Epidemiology and Public Health at the University of Maryland School of Medicine with a joint appointment in UM-IHC, were also co-authors of the study.
This research was supported by the National Institutes of Health’s National Institute on Aging (Award Nos. R01AG089377, P30AG028747, R01AG048069, R01AG079854 and K76AG074926). This article does not necessarily reflect the view of this organization.
The paper, “Particulate Air Pollution and Post-Discharge Recovery Among Older Adults Hospitalized for Heart Failure in the United States,” by Tong Wen, Jingwen Hu, Michelle Shardell, Rozalina McCoy, Shuo Chen, Kathleen Ryan, Jason Falvey, and Chixing Chen was published in Gerontol A Biol Sci Med Sci. on February 5, 2026.
