Hot Weather Intensifies Symptoms and Complicates Care for Older Heart Patients

More than half of older cardiology outpatients who gave a clear response said their cardiovascular symptoms became worse during hot summer weather, according to a convergent mixed-methods study published in BMC Geriatrics. The study, conducted among adults aged 65 and older at an outpatient clinic, suggests that the effects of heat go beyond emergency admissions and can also affect daily symptoms, routine functioning, and access to timely care. The researchers said clinical vulnerability, limited indoor cooling, and practical barriers to getting care can combine during periods of high heat, increasing the risk of deterioration and delayed treatment.

The research took place at the cardiology outpatient clinic of a tertiary university hospital in Zonguldak, Türkiye, and enrolled 680 patients aged 65 or older. The team set out to examine how medical conditions, housing circumstances, and healthcare barriers interact during summer heat. Although heat is already known to be a cardiovascular risk, the authors noted that detailed evidence on how frailty, cooling constraints, and disruptions to regular outpatient care affect older heart patients has remained limited.

All 680 participants completed an interviewer-led questionnaire covering heat-related symptoms, home cooling conditions, obstacles to healthcare access, and baseline physical frailty. Frailty was assessed with the Clinical Frailty Scale (CFS). The main outcome was self-reported worsening of cardiovascular symptoms due to heat, while secondary outcomes included delayed care and major negative effects on daily life. The researchers also used multivariable logistic regression and a seven-domain heat-vulnerability index to assess overlapping risk factors in the outpatient group.

Among the participants, the average age was 71.3 years and 48.1 percent were women. In total, 82.4 percent reported that their living spaces did not provide adequate effective cooling. In addition, 75.9 percent experienced at least two heat-related symptoms during warm periods, and 30.9 percent said heat caused delays in care. Looking specifically at cardiovascular symptoms, 52.1 percent of patients who answered definitively reported that their symptoms worsened in hot weather.

Regression analysis found that several clinical and environmental factors were independently linked to heat-related worsening of cardiovascular symptoms. A history of heart failure nearly doubled the odds, with an adjusted odds ratio of 1.86 and a 95 percent confidence interval of 1.18 to 2.95. Spending long periods in hot indoor environments also raised risk, with an adjusted odds ratio of 1.82 (95 percent confidence interval, 1.19 to 2.81). Summer transportation problems were another independent factor (adjusted odds ratio 1.65, 95 percent confidence interval 1.08 to 2.53), as was greater frailty, with each one-point increase on the Clinical Frailty Scale associated with higher odds of worsening (adjusted odds ratio 1.30, 95 percent confidence interval 1.09 to 1.55).

Delays in obtaining needed care were also strongly tied to social and practical limitations. The largest independent predictor was the lack of daytime personal support, which nearly tripled the likelihood of care disruption (adjusted odds ratio 2.99, 95 percent confidence interval 2.05 to 4.35). Difficulties arranging transportation during the summer were similarly associated with 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 lower household income doubled the odds of delayed care (adjusted odds ratio 2.02, 95 percent confidence interval 1.34 to 3.03).

To add depth to the survey findings, the researchers selected 20 participants for semi-structured interviews, which were analyzed thematically and then integrated with the quantitative results. Those interviews showed that home cooling, access to healthcare, and social support mattered in practice, not just in theory, meaning that simply having a cooling device or support network did not necessarily translate into real protection during extreme heat.

The authors concluded that hot weather can have serious effects on older cardiology outpatients well beyond acute emergencies, disrupting symptom control, daily functioning, and continuity of cardiovascular care. Because the risk comes from a combination of medical conditions, frailty, indoor heat exposure, and social isolation, they suggested that outpatient cardiovascular clinicians consider brief heat-health discussions as part of 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

Keywords: cardiology, geriatrics, heat vulnerability, frailty, heart failure, healthcare access, cooling constraints, mixed-methods study, heat-related, symptom, worsening, cooling