gms | German Medical Science

Background: The effects of climate change pose a severe health threat to humankind. One major effect of climate change in the near future is the prognosed increase in heat waves. In 2018, 8700 deaths were attributable to heat in Germany [1]. One risk factor for mortality during heat waves may be the use of certain medications (e.g., drugs with anticholinergic properties) that increase heat-related health risks by impairing the ability of the human organism to adapt to heat [2]. To address this risk, it is important to sensitise physicians, educate patients and adjust medication schedules. Yet, a representative survey with physicians in Germany conducted in 2021 revealed that only 16% of the participating physicians adjust medication plans during heat waves [1]. The purpose of our investigation is to provide an overview of possible future concepts to improve heat-preparedness of physicians in Germany regarding heat-related health disorders due to use of particular medications.

Materials and Methods: An exploratory search of existing concepts was performed, followed by brainstorming sessions with experts from general medicine and health services research.

Results: No standardised concept regarding heat-related health risks induced by medication intake in primary care was found. Some studies showing individual heat-related drug interactions were detected [3], [4]. In addition, currently only one structured approach (“Heidelberger Hitze-Tabelle” [5]) listing drugs with potential risks during heat waves and providing risk minimisation measures was found. To date, the German Health Care System lacks an evidence- and consensus-based list that combines information on potential health risk-inducing medication during heat waves with specific recommendations for the care of high-risk patients (similar to e.g. the PRISCUS list for potentially inappropriate medications in elderly patients). Rather than focusing only on drugs and their potential heat-related implications, the list should also include relevant patient groups that are particularly vulnerable to heat-related health disorders due to morbidity, age, or gender.

In order to sensitise physicians to the issue, the results of the list should be incorporated into education and training programs. The information from an evidence-based list can also be used to educate patients about the dangers during consultations or through information material. Additional research is required to identify the most appropriate format for patient education. Interdisciplinary approaches involving physicians and possibly also pharmacists to inform patients are conceivable, as well as innovational concepts such as individual-level early warning systems based on secondary and real-world data.

Conclusion: New structures and processes are needed to address heat-related illnesses caused by medication. Firstly, more evidence-based information about potential heat-related health risks and patients at risk is required. This information is crucial for developing guidelines for physicians to adjust medication of these at-risk patients. Secondly, a discussion with interdisciplinary stakeholders on the framework conditions that are necessary to implement these recommendations in practice should follow. Based on our findings, we would like to initiate a discussion in the German health services research and primary care communities on this topic.