Heart-related death risk higher while firefighters battle blazes

LOS ANGELES -- Firefighters face a far greater risk of dying of heart problems while battling a blaze than was thought, suggests a large US study that offers more evidence of their need to stay in shape.

The risk of a heart-related death while putting out a fire was up to 100 times higher than the risk during downtime, Harvard researchers found, even though fighting fires accounts for only a small percentage of these workers' time.

About 100 firefighters die in the line of duty each year, and previous research has shown that nearly half of the deaths are due to heart disease. The vast majority, about 70 percent, of the nation's roughly 1 million firefighters are volunteers.

Specialists say diet and exercise should be priorities at the firehouse.

Dr. Stefanos N. Kales of Cambridge Health Alliance and Harvard Medical School led the study that looked at the types of tasks firefighters did -- responding to a fire, putting it out, returning from a call, training, etc. -- to see how these tasks were associated with death. They reviewed data on deaths from 1994 through 2004, excluding the 343 firefighters who died from the Sept. 11 , 2001, terrorist attacks.

"This provides the strongest evidence to date that specific firefighting duties can precipitate coronary events," Kales said.

"You may not be able to prevent all these deaths, but to the degree you can prevent some deaths by paying attention to underlying risk factors and better fitness programs, that's the goal," said Dr. Linda Rosenstock, dean of the UCLA School of Public Health, who was not involved in the study.

The study, published today in The New England Journal of Medicine, doesn't address whether firefighters have an overall higher risk of dying from heart disease than the general population.

About 70 percent of fire departments don't have programs to promote fitness, according to the Quincy-based National Fire Protection Association.

"One of the issues for fire services is coming up with the funding to have medical evaluations" and fitness programs, said Rita Fahy, manager of fire databases and systems for the association.

In the Harvard study, researchers examined a federal registry of 1,144 on-duty firefighter deaths between 1994 and 2004.

Nearly 40 percent -- or 449 -- of the on-duty deaths during that period were due to heart disease. Thirty-two percent of the heart-related deaths occurred while fighting blazes, 13 percent responding to an alarm, 17 percent returning from a call, and 13 percent during physical training.

The researchers also calculated the odds of dying from a heart attack by taking into account the estimated amount of time spent performing different duties.

They found the risk of death from heart disease was highest during active firefighting -- up to 100 times greater than the risk of dying during administrative work -- though firefighting made up no more than 5 percent of a firefighter's time. Increased risk of death was also found for other emergency duties such as responding to a call and returning from the scene of a fire.

The study was funded by the National Institute for Occupational Safety and Health and the Massachusetts Public Employees Retirement Administration Commission. Kales and another author have served as paid expert witnesses in workers' compensation cases, including some involving firefighters.

Fire Sergeant Jeff Brause of Michigan had a heart attack in 2004 while responding to a house fire. Brause, who was 45 at the time, didn't have a family history of heart disease.

"I started getting a burning sensation in my chest," he recalled. "I thought I must be getting old or maybe pulled a muscle."

Firefighter groups are increasingly taking notice of heart risk. The National Volunteer Fire Council in 2003 began an awareness program promoting fitness and nutrition, and volunteers offer free health screening and demonstrate healthy cooking and fitness techniques.

Globe correspondent Elizabeth Cooney contributed to this report. For more information, go to nejm.org and hsph.harvard.edu