According to a cross-sectional study published in the Journal of the American Medical Association Network Open, older adults hospitalized with a RSV infection are at greater risk for acute cardiac events and severe clinical outcomes.
The authors wrote, “Respiratory syncytial virus (RSV) infection can cause severe respiratory illness in older adults. Less is known about the cardiac complications of RSV disease compared with those of influenza and SARS-CoV-2 infection.”
In this cross-sectional study, the researchers aimed to describe the prevalence and severity of acute cardiac events during hospitalizations among adults aged 50 years or older with RSV infection by gathering and evaluating surveillance data from the RSV Hospitalization Surveillance Network. The network conducts detailed medical record abstraction among hospitalized patients with RSV infection identified through clinician-directed laboratory testing.
Cases of RSV infection in adults aged 50 years or older within 12 states over five RSV seasons (annually from 2014–2015 through 2017–2018 and 2022–2023) were inspected to approximate the weighted period prevalence and 95% CIs of acute cardiac events.
The secondary objectives of the study were to detect risk factors for experiencing an acute cardiac event and to ascertain whether acute cardiac events are independently correlated with an augmented risk of severe outcomes. Severe disease outcomes were established as ICU admission, need for invasive mechanical ventilation, or in-hospital mortality. To compare severe outcomes among patients with and without acute cardiac events, the researchers calculated adjusted risk ratios (ARR).
The study included 6,248 hospitalized adults, and characteristics of the study cohort included median (interquartile) age: 72.7 years (with a range between 63.0 and 83.2 years); 59.6% female and 56.4% had a history of underlying cardiovascular disease (CVD) with laboratory-confirmed RSV infection. Additional history of CVD documented in medical records included heart failure (31.9%), coronary artery disease (30.2%), and atrial fibrillation (25.2%). A history of smoking (36.8%) or current smoking (15.7%) was common, and 93.1% had fever or respiratory symptoms documented in the medical record at admission. The percentage of race and ethnicity groups was recorded as Caucasian (65.9%), followed by African American (16.0%), Asian or Pacific Islander (7.3%), and Hispanic or Latino (6.6%).
The results revealed that the weighted estimated prevalence of experiencing a cardiac event was 22.4%. The weighted estimated prevalence was 15.8% for acute heart failure, 7.5% for acute ischemic heart disease, 1.3% for hypertensive crisis, 1.1% for ventricular tachycardia, and 0.6% for cardiogenic shock.
The results also indicated that, “Adults with underlying cardiovascular disease had a greater risk of experiencing an acute cardiac event relative to those who did not (33.0% vs 8.5%; ARR, 3.51; 95% CI, 2.85-4.32). Among all hospitalized adults with RSV infection, 18.6% required ICU admission, and 4.9% died during hospitalization. Compared with patients without an acute cardiac event, those who experienced an acute cardiac event had a greater risk of ICU admission (25.8% vs 16.5%; ARR,1.54; 95% CI, 1.23-1.93) and in-hospital death (8.1% vs 4.0%; ARR, 1.77; 95% CI, 1.36-2.31).”
Based on their findings, the authors concluded that over five RSV seasons, data from this cross-sectional study revealed that almost 25% of hospitalized adults aged 50 years or older with RSV infection experienced an acute cardiac event, with the most commonly occurring reported as acute heart failure, which occurred in one in 12 adults (8.5%) with no documented underlying cardiovascular disease.
The authors also noted that another novel discovery of this study was the documentation of less common but life-threatening events that may transpire in the context of RSV infection, including ventricular tachycardia, hypertensive crisis, cardiogenic shock, and acute myocarditis.
The authors wrote, “Although acute cardiac events identified in this study cannot be definitively attributed to RSV infection, these findings suggest that acute cardiac events occur frequently among hospitalized older adults with RSV infection and are associated with greater illness severity. Results from this study support previous findings that acute heart failure, coronary events, and atrial fibrillation occur frequently among adults hospitalized with acute respiratory infections, including influenza and SARS-CoV-2.”
Lastly, the authors wrote, “The risk of severe outcomes was nearly twice as high in patients with acute cardiac events compared with patients who did not experience an acute cardiac event. These findings clarify the baseline epidemiology of potential cardiac complications of RSV infection prior to RSV vaccine availability.”
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