Rising Global Temperatures Increase Heat-Related Mortality in Older Patients With Heart Failure – AJMC

Report on Climate Change, Cardiovascular Health, and Sustainable Development Goals

Introduction: The Intersection of Climate Action and Public Health

Recent research highlights the critical link between rising global temperatures and adverse public health outcomes, directly impacting the achievement of several Sustainable Development Goals (SDGs). A study published in JAMA Cardiology reveals that extreme temperatures exacerbate cardiovascular mortality among older adults with heart failure (HF). This finding underscores the urgency of SDG 13 (Climate Action), as escalating greenhouse gas (GHG) emissions contribute to nonoptimal temperatures (NOTs) that disrupt human physiological functions. The health and well-being of vulnerable populations are at significant risk, challenging the core principles of SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities).

Key Findings on Health Impacts and Vulnerabilities

The analysis demonstrates a direct correlation between climate change and health crises, with specific implications for aging populations.

• Increased Vulnerability: Older adults with pre-existing conditions such as heart failure are disproportionately affected by temperature extremes. Heat-related mortality in individuals over 65 has increased by 167% since the 1990s, indicating a failure to protect vulnerable groups as mandated by SDG 3.
• Nonlinear Mortality Risk: The relationship between temperature and mortality is nonlinear, following a U- or J-shaped curve. This “minimum mortality temperature” (MMT) curve shows that both extreme cold and extreme heat significantly increase mortality risk.
• Swedish Case Study Findings: A time-stratified study in Sweden involving 250,640 patients with HF confirmed this trend. The key statistical findings include:
  1. For all-cause mortality, the odds ratio (OR) was 1.130 for low temperatures and 1.054 for high temperatures.
  2. For cardiovascular mortality, the OR was 1.160 for low temperatures and 1.084 for high temperatures during the 2014-2021 period.
• Demographic Trends: The increasing vulnerability is attributed not only to climate trends but also to demographic shifts, such as Sweden’s rapidly aging population. This demographic pressure further complicates the objectives of ensuring healthy lives for all ages (SDG 3).

Geographic Disparities and the Need for Resilient Infrastructure (SDG 11)

The research uncovered significant geographic variations in heat-related mortality, which provides crucial insights for developing sustainable and resilient communities.

• Adaptation Gaps: Contrary to expectations, heat wave-related mortality rates were higher in regions with polar and alpine climates, such as Eastern and Northern Europe, compared to tropical locations. This disparity is attributed to a lack of physiological, behavioral, and infrastructural adaptation to extreme heat.
• Implications for SDG 11: These findings highlight an urgent need to advance SDG 11 (Sustainable Cities and Communities) by developing climate-resilient infrastructure and public health strategies tailored to local vulnerabilities, ensuring that communities are prepared for climate shocks.
• Data Deficiencies: A significant lack of data on heat-related mortality was noted for countries in South Asia and the Middle East. This information gap impedes the development of equitable global health policies and underscores the challenge of reducing inequalities (SDG 10).

Policy Implications and Strategic Recommendations for SDG Alignment

The evidence necessitates immediate and integrated policy responses that align climate action with public health objectives.

1. Integrate Climate and Health Policy: Governments must develop and implement urgent climate adaptation strategies that prioritize the health of at-risk populations. This directly supports the interconnected goals of SDG 3 and SDG 13.
2. Enhance Climate-Resilient Health Systems: Health care infrastructure must be strengthened to manage the growing burden of climate-sensitive conditions. This includes early warning systems and targeted support for older adults and those with chronic illnesses.
3. Promote Sustainable Urban Planning: In line with SDG 11, urban development must incorporate climate adaptation measures, such as green spaces and cooling centers, to protect residents from temperature extremes.
4. Address Research Gaps: Further research is required to understand geographic disparities in climate-related health outcomes, particularly in data-poor regions, to ensure that global efforts to combat climate change are equitable and effective.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article highlights issues that are directly connected to several Sustainable Development Goals (SDGs). The primary connections are to health, climate change, and sustainable communities, focusing on the vulnerability of specific populations.

• SDG 3: Good Health and Well-being: The core theme of the article is the adverse health impact of extreme temperatures, specifically the exacerbation of cardiovascular mortality in older patients with heart failure. It directly discusses mortality rates, disease, and the vulnerability of an aging population, which are central to SDG 3.
• SDG 13: Climate Action: The article explicitly attributes the rise in ambient temperatures to increasing greenhouse gases (GHGs) from fossil fuels. It discusses global CO₂ emissions, the GHG index, and the need for “climate adaptation strategies,” linking the health crisis directly to the broader issue of climate change and the urgent need for action.
• SDG 11: Sustainable Cities and Communities: The article touches upon the concept of adaptation to climate change within human settlements. It mentions how geographic variations in mortality are linked to how populations have “physiologically, behaviorally, and infrastructurally adapted to extreme heat,” pointing to the role of community and infrastructure resilience in protecting vulnerable residents.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, several specific SDG targets can be identified:

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • The article’s focus is on “cardiovascular mortality in older patients with heart failure.” Heart failure is a non-communicable disease, and the research presented quantifies the increased risk of premature death due to an environmental factor (extreme temperatures), making this target highly relevant.
2. Target 13.1: Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters in all countries.
   • The article emphasizes the lack of adaptation in certain populations, noting that areas with polar or alpine climates had higher heat-related death rates because they are “less likely to have physiologically, behaviorally, and infrastructurally adapted to extreme heat.” The conclusion calls for “urgent need for climate adaptation strategies for at-risk older adult populations,” directly aligning with this target.
3. Target 13.2: Integrate climate change measures into national policies, strategies and planning.
   • The article provides a concrete example of national policy by referencing a “proposed ruling, from the Environmental Protection Agency, under the Trump administration,” which aimed to repeal limits on GHG emissions from “fossil fuel–fired power plants.” This is a direct reference to national-level policy decisions that impact climate change.
4. Target 11.5: By 2030, significantly reduce the number of deaths and the number of people affected… by disasters… with a focus on protecting the poor and people in vulnerable situations.
   • Extreme temperature events are climate-related hazards. The article centers on the resulting deaths (“heat-related premature deaths”) and specifically focuses on a vulnerable population: “older patients with HF” and “persons over the age of 65.” This aligns perfectly with the target’s goal of reducing deaths from disasters while protecting vulnerable groups.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions several quantitative and qualitative indicators that can be used to measure progress.

• Mortality Rates and Odds Ratios (ORs) for Cardiovascular Disease: To measure progress towards Target 3.4, the article provides specific data points. For instance, it cites a study where “For cardiovascular mortality, low temperatures were associated with an OR of 1.160… and high temperatures with an OR of 1.084.” Tracking these mortality statistics in relation to temperature extremes serves as a direct indicator of premature mortality from non-communicable diseases.
• Statistics on Heat-Related Deaths in Vulnerable Populations: As an indicator for Targets 13.1 and 11.5, the article states that “Heat-related mortality in persons over the age of 65 has increased by 167% since the 1990s.” This statistic directly measures the number of deaths in a vulnerable group attributed to a climate-related hazard, which can be used to assess the effectiveness of adaptation and resilience strategies over time.
• Greenhouse Gas (GHG) Index: The article references the “2024 Annual GHG index,” which “was 1.51, a nearly 51% increase in the total warming effect since the 1990s.” This index is a clear indicator for tracking the root cause of the climate change discussed in the article and is relevant to the overarching goals of SDG 13.
• National Climate Policies and Regulations: As a qualitative indicator for Target 13.2, the article points to a specific policy action: the EPA’s proposed repeal of “climate pollution limits on fossil fuel power plants.” The existence, implementation, or repeal of such national policies serves as an indicator of a country’s commitment to integrating climate change measures into its planning.

4. Summary Table of SDGs, Targets, and Indicators

Source: ajmc.com