Effectiveness of Indoor Air Purifiers on Heart Failure Outcomes (The PURI-HF Trial)

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Project Abstract: Effectiveness of Indoor Air Purifiers on Heart Failure Outcomes (PURI-HF Trial) Indoor air pollution is one of the leading risk factors for global mortality, with over 90% of pollution-related deaths occurring in low- and middle- income countries (LMICs). Fine mode particulate matter with an aerodynamic diameter smaller than 2.5 micrometers (PM2.5) is a major contributor to global morbidity and mortality, particularly due to cardiovascular disease (CVD). There is a strong link between both acute and chronic PM2.5 air pollution exposure and heart failure (HF) incidence, hospitalizations, and mortality. Most recommendations to reduce air pollution-mediated CVD have focused on improved cooking techniques and ventilation, but with mixed results. New strategies to improve air quality and cardiovascular health are needed. For the past few decades, high-efficiency particulate air (HEPA) purifiers have been studied in LMICs to decrease PM2.5 pollution and improve health outcomes. However, there remain substantial gaps in understanding the long-term effects of air purifiers on functional and clinical HF outcomes. We are an established group of investigators with a successful track record of innovative and impactful studies at the intersection of air pollution and CVD. We will leverage our experience to study the impact of an innovative approach to reduce the adverse impact of air pollution and improve HF outcomes in India. The PURI-HF Trial aims to demonstrate the efficacy, feasibility and effectiveness of portable air filters in improving indoor PM2.5 levels and improving functional capacity of HF patients with reduced ejection fraction (HFrEF) in India. Our proposed partnership between NYU Grossman School of Medicine and All India Institute of Medical Sciences will emphasize capacity building and cross-institutional training opportunities throughout the duration of the project. Aim 1 will be a randomized controlled trial to evaluate the effectiveness of indoor air purifiers on HF functional capacity (6-minute walk test) among patients with HReEF in Delhi, Ludhiana, and Thiruvananthapuram. We will also conduct a moderation analysis to evaluate whether level of ambient air pollution, as well as spatial/environmental factors, moderate the impact of air purifiers on HF outcomes. Aim 2 will involve a causal mediation analysis to determine if the reduction in PM2.5 is associated with the relationship between air purifiers and HF outcomes. We will also assess whether seasonality correlates with the reduction in indoor PM2.5 concentrations in participant households, and we will determine the impact of air purifier use on the composition of PM2.5 air pollution in the three study sites. Aim 3 will be comprised of a cost-effectiveness analysis and process evaluation of the intervention. The research will be conducted by a transdisciplinary research team with diverse and complementary expertise led by two experienced Principal Investigators. We intend to add to existing knowledge of innovative and scalable strategies to improve environmental and cardiovascular health worldwide.