Higher Vaccination Rates Improve Outcomes in Heart Failure During Respiratory Virus Season

Although patients with heart failure should be vaccinated against respiratory illnesses, including respiratory syncytial virus (RSV) and the flu, to reduce morbidity, mortality, and hospitalization, vaccination administration rates remain low, and outcomes for hospitalized patients are worse. Vaccination is recommended per American Heart Association/American College of Cardiology/Heart Failure Society of American Guidelines.

Two abstracts presented at the Heart Failure Society of American 2024 Annual Meeting evaluated the relationships between heart failure and RSV and the flu, respectively.

In the first study,¹ investigators conducted a retrospective analysis of National Inpatient Sample Data from 2016 to 2020 to determine whether hospital outcomes—including in-hospital mortality, acute kidney injury with or without dialysis, and acute respiratory failure with or without mechanical ventilation—were higher in patients with RSV.

In total, 183,985 primary heart failure hospitalizations were analyzed, of which 5.9% had a diagnosis of heart failure. Although there were no significant between-group differences in in-hospital mortality between patient groups with and without RSV, these with RSV experienced acute kidney injury, acute kidney injury requiring dialysis, acute respiratory failure, and acute respiratory failure requiring mechanical ventilation at sigificnatly higher rates than patients without RSV. Results of a regression analysis demonstrated that those with heart failure had significantly higher odds for acute kidney injury (aOR, 1.64; 95% CI, 1.44-1.87), acute kidney injury requiring dialysis (aOR, 1.98; 95% CI, 1.81-2.06), acute respiratory failure (aOR, 1.15; 95% CI, 1.05-1.18), and acute respiratory failure requiring mechanical ventilation (aOR, 2.91; 95% CI, 2.13-3.97).

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The present study has demonstrated that RSV infection among patients with [heart failure] is associated with greater adverse clinical outcomes,” the researchers concluded. “The findings of this study highlight the necessity for intensified endeavors to enhance RSV vaccination rates and create vaccines that offer more comprehensive immunity.”

In the second study,² researchers from Johns Hopkins University implemented a target quality initiative at the Johns Hopkins HF Bridge Clinic with the goal of improving flu vaccination rates. During patient appoints held between September 2023 and January 2024, staff determined patient eligibility for flu vaccination receipt; those patients were offered the vaccine and the opportunity to receive it during their appointment.

A total of 220 patients were screened for flu vaccine eligibility, of whom 78 were eligible. A total of 43.5%, or 34 patients, received the vaccine during their appointment. This was a notable increase over the 2021-2022 flu season, where no flu vaccines were administered during the clinic. In total, 130 patients had already received their flu vaccine prior to their clinic appointment, making them ineligible to receive the vaccine at the clinic.

“Through a targeted quality improvement initiative in a [heart failure] disease management clinic, vaccination rates improved from previous flu seasons,” the researchers noted. “Barriers to this quality initiative include staff workflow adaptation and education, time constraints during complex clinical visits, and flu vaccine availability.”

“Ongoing efforts are needed to improve delivery of evidence-based care, such as vaccinations, to patients with [heart failure],” the concluded.

Click here for more coverage of the Heart Failure Society of America 2024 Annual Meeting.

References

1. Carcamo FJJ, Rubens M, Saxena A, et al. Impact of respiratory syncytial virus on hospital outcomes among patients with heart failure. Presented at: Heart Failure Society of America 2024 Annual Meeting; September 27-30, 2024; Atlanta, GA. Poster 315.

2. Schittino A, Seidl K, Robinson M, et al. Increasing flu vaccination rates among a high-risk patient cohort through a heart failure disease management clinic quality initiative. Presented at: Heart Failure Society of America 2024 Annual Meeting; September 27-30, 2024; Atlanta, GA. Poster 326.