More than half of older cardiology outpatients who provided a definite response experienced a worsening of their cardiovascular symptoms during hot summer weather, according to a convergent mixed-methods study published in BMC Geriatrics. Conducted among adults aged 65 and older attending an outpatient clinic, the investigation demonstrated that heat-related health burdens extend beyond acute hospital admissions to affect daily symptoms, everyday functioning, and timely medical care. The research team highlighted that clinical vulnerability, severe indoor cooling limitations, and logistical hurdles intersect during elevated summer temperatures, placing vulnerable individuals at heightened risk of clinical deterioration and delayed care.
The study was carried out between June and August 2026 at the cardiology outpatient clinic of a tertiary university hospital located in Zonguldak, Türkiye. The investigators consecutively enrolled 680 patients aged 65 years or older to evaluate how patient-level clinical factors, housing characteristics, and systemic healthcare barriers converge during summer heat. While hot weather represents an established hazard for cardiovascular health, the authors noted that granular, patient-level evidence examining how clinical susceptibility, practical cooling constraints, and disruptions to routine medical consultations interact in older cardiology cohorts has historically remained scarce.
To assess these complex interactions, all 680 participants completed a structured, interviewer-administered survey designed to capture self-reported heat-related symptoms, domestic housing and cooling capacity, healthcare access barriers, and baseline physical frailty. Frailty was measured systematically using the Clinical Frailty Scale (CFS). The primary outcome evaluated was self-reported heat-related worsening of cardiovascular symptoms, while secondary outcomes tracked heat-related care delay and marked adverse impacts on daily living. In addition to multivariable logistic regression analyses, the researchers explored a pragmatic seven-domain heat-vulnerability index to evaluate multidimensional risk profiles across the outpatient sample.
Among the surveyed cohort, the mean age was 71.3 years (standard deviation 5.3 years), and 48.1 percent of the participants were women. Overall, 82.4 percent of the older patients reported inadequate effective cooling within their living environments. Furthermore, 75.9 percent reported experiencing at least two heat-related symptoms during warm periods, and 30.9 percent reported facing heat-related care delays. When evaluating cardiovascular symptoms specifically, 52.1 percent of patients who gave a definite answer reported that their cardiovascular symptoms worsened during hot weather conditions.
Multivariable logistic regression revealed that heat-related worsening of cardiovascular symptoms was independently associated with several distinct clinical and environmental factors. A diagnosed history of heart failure nearly doubled the odds of symptom worsening, yielding an adjusted odds ratio of 1.86 with a 95 percent confidence interval of 1.18 to 2.95. Prolonged exposure to hot indoor environments similarly increased risk, showing an adjusted odds ratio of 1.82 (95 percent confidence interval, 1.19 to 2.81). In addition, summer transport difficulty was independently associated with symptom worsening (adjusted odds ratio 1.65, 95 percent confidence interval 1.08 to 2.53), as was greater frailty, where each one-point increase on the Clinical Frailty Scale was associated with higher odds of deterioration (adjusted odds ratio 1.30, 95 percent confidence interval 1.09 to 1.55).
Heat-related delays in seeking or receiving necessary healthcare represented another significant challenge, associated primarily with social vulnerability, economic resources, and mobility constraints. The strongest independent association with care delay was the absence or limitation of daytime personal support, which tripled the likelihood of disruption (adjusted odds ratio 2.99, 95 percent confidence interval 2.05 to 4.35). Difficulties securing transportation during summer months were also strongly associated with care delays (adjusted odds ratio 2.59, 95 percent confidence interval 1.67 to 4.00). Living alone was linked to an adjusted odds ratio of 2.45 (95 percent confidence interval 1.62 to 3.70), while insufficient household income doubled the odds of experiencing care delays (adjusted odds ratio 2.02, 95 percent confidence interval 1.34 to 3.03).
To complement the quantitative findings, the investigators purposively sampled 20 participants for semi-structured qualitative interviews, which were analyzed thematically and integrated directly with the survey data. Crucially, the interview narratives demonstrated that effective home cooling, healthcare access, and social support networks were governed by practical usability rather than their nominal availability, illustrating that having a cooling device or support system on paper did not guarantee effective relief or protection during extreme weather.
The authors concluded that the adverse consequences of hot weather among older cardiology outpatients manifest well beyond acute medical emergencies, significantly undermining daily functioning, symptom control, and the overall continuity of cardiovascular care. Because vulnerability arises from an interlocking matrix of clinical conditions, physical frailty, environmental indoor heat exposure, and social isolation, the researchers suggested that outpatient cardiovascular clinicians consider incorporating brief heat-health discussions into routine visits.
Subject of Research: Impact of summer heat on older cardiology outpatients
Article Title: Heat-related symptom worsening, cooling constraints, and care disruption among older cardiology outpatients: a convergent mixed-methods study
Article References: Ekemen, A., Açıkgöz, B., Eriş Güdül, N., Fatiş, Ö., & Ayoğlu, F. N. (2026). Heat-related symptom worsening, cooling constraints, and care disruption among older cardiology outpatients: a convergent mixed-methods study. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08563-8
Image Credits: AI Generated
DOI: 10.1186/s12877-026-08563-8
Keywords: cardiology, geriatrics, heat vulnerability, frailty, heart failure, healthcare access, cooling constraints, mixed-methods study, Heat-related, symptom, worsening, cooling
