Heart failure (HF) patients often end up in the hospital with infection-related diagnoses, including many that could be prevented with appropriate vaccinations. 

That’s according to a presentation at the recent European Society of Cardiology conference. University of Connecticut researchers looked at medical records of nearly 3 million Americans to determine the risk of vaccine-preventable diseases (VPDs) in patients with HF.

Performing a population-based retrospective cohort study using the United States- National Inpatient Sample (NIS) Database from 2010 to 2014, the study team identified HF patients who were admitted to the hospital with VPDs. Included were influenza, varicella zoster infection (VZV), pneumococcal infection, meningococcal infection, diphtheria, pertussis, tetanus, hepatitis A (Hep A), and hepatitis B (Hep B).

HF was present in 8.8% of patients admitted with VPDs. The most common was VZV (30.7%), followed by influenza (28.2%), pneumococcal infection (20.9%), and Hep B (18.5%). Researchers note that other VPDs were less common, including Hep A (1.8%), diphtheria (0.4%), pertussis (0.2%), tetanus (10 patients), and meningococcal infection (0.1%). 

Results indicate that on multivariate analysis, patients with HF had increased risk of hospitalization due to influenza (aOR = 1.20, 95% CI: 1.18-1.21; P <0.001) and pneumococcal infection (aOR = 1.31, 95% CI: 1.29-1.33; P <0.001), but were at a lower risk of hospitalization due to VZV (aOR = 0.81, 95% CI: 0.8-0.83; P <0.001), Hep B (aOR = 0.78, 95% CI: 0.77- 0.8; P <0.001), Hep A (aOR = 0.71, 95% CI: 0.67-0.74; P <0.001), meningococcal infection (aOR = 0.64, 95% CI: 0.52-0.78; P <0.001), diphtheria (aOR = 0.79, 95% CI: 0.71-0.88; P <0.001), and tetanus (aOR = 0.35, 95% CI: 0.19-0.65; P = 0.001). No statistically significant association of HF was observed with pertussis (P = 0.167).

“In our study, patients with HF had a higher risk of hospital admissions secondary to influenza and pneumococcal infections and a lower risk of VZV, Hep B, Hep A, meningococcal infection, diphtheria, and tetanus related admissions when compared with non-HF patients,” the authors write.

In a related study, some of the same researchers point out that vaccinating patients against respiratory ailments is linked with fewer hospital deaths in HF patients. 

“The COVID-19 pandemic has shone the spotlight on the importance of vaccination to prevent respiratory infections, particularly for people with diseases like heart failure,” explained study author Dr. Karthik Gonuguntla, MD, of the University of Connecticut.

Respiratory infections are known to exacerbate HF, but few studies have compared outcomes of vaccinated versus unvaccinated patients. Included in the study were 2.9 million patients with HF, average age 70 years, who had a hospital admission in 2010 to 2014 in the National Inpatient Sample. 

Of those patients, just 1.4% were found to have had the pneumonia vaccine, with a similar percentage getting a flu shot. Results indicate that rates of in-hospital mortality were significantly lower in patients who received the pneumonia vaccine (1.2%) compared with those who were not inoculated (3.6%). Results were similar with the flu vaccine: 1.3% versus 3.6%.

“Our study provides further impetus for annual immunizations in patients with heart failure,” Dr. Gonuguntla points out. “Despite advice to do so, uptake remains low. Although large administrative databases like the NIS are prone to containing some errors, the data indicate that there is some distance to go before reaching 100% coverage.”
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