Influenza vaccination and mortality among adults with heart failure in an integrated healthcare delivery system, 2009–2018

Abstract

BACKGROUND: Influenza infection can result in decompensation or exacerbation of heart failure (HF) symptoms, hospitalization, and death. OBJECTIVE: To examine the association of influenza vaccination with mortality and hospitalization during influenza and non-influenza seasons between 2009 and 2018. DESIGN, SETTING, AND PARTICIPANTS: In this prospective, observational cohort study, we included Kaiser Permanente Southern California members with a HF diagnosis prior to September 1 each year from 2009 to 2017. EXPOSURE: The first influenza vaccination in each season (September 1 to May 31) was recorded. Vaccinated/ unvaccinated patients were matched 1:1 on age, sex, and ejection fraction at the vaccination date (n-total = 74,870). MAIN OUTCOMES: Patients were followed through the end of each influenza season for all-cause mortality. Secondary outcomes included cardiovascular mortality and all-cause hospitalization. In a sensitivity analysis, we examined mortality in the non-influenza season. RESULTS: Influenza vaccinated vs unvaccinated patients had more comorbidities and higher healthcare utilization. After multivariable adjustment for utilization, sociodemographics, comorbidities, and medications, influenza vaccinated vs unvaccinated patients had a lower risk of all-cause mortality and cardiovascular mortality during the influenza season (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.63, 0.70 and HR 0.68, 95% CI 0.63, 0.74, respectively) but a higher risk of allcause hospitalization (HR 1.27, 95% CI 1.21, 1.31). There was no association between influenza vaccination and allcause or cardiovascular mortality during the noninfluenza season (HR 0.99, 95% CI 0.89, 1.09 and HR 1.00, 95% CI 0.84, 1.21, respectively). CONCLUSIONS: Influenza vaccination in HF patients was associated with a lower risk of mortality during the influenza season. Our findings provide support for recommendations of universal influenza vaccination in patients with HF.

Vacinação Contra Influenza E Insuficiência Cardíaca

“…O estudo de Matthew T Mefford concluiu que a vacinação contra influenza pode ser benéfica para pacientes com IC na redução do risco de mortalidade durante a temporada de influenza. Os achados forneceram suporte para recomendações de diretrizes nacionais e internacionais de vacinação universal contra influenza em pacientes de alto risco (Mefford, 2021). pacientes com IC (Mohseni, 2017).…”

Association of post‐vaccination adverse reactions after influenza vaccine with mortality and cardiopulmonary outcomes in patients with high‐risk cardiovascular disease: the INVESTED trial

“…Influenza is common and associated with an increased risk of hospitalization for heart failure and myocardial infarction in patients with high‐risk cardiovascular disease 1–4 . Influenza vaccination has been associated with a reduction of adverse cardiovascular events in observational studies and in meta‐analyses of randomized trials, and is recommended as secondary prevention in high‐risk individuals 5–10 …”

“…[1][2][3][4] Influenza vaccination has been associated with a reduction of adverse cardiovascular events in observational studies and in meta-analyses of randomized trials, and is recommended as secondary prevention in high-risk individuals. [5][6][7][8][9][10] Despite widely recognized beneficial effects of influenza vaccines, concerns about vaccine-related adverse reactions and possible long-term adverse effects continue to be barriers for patients considering vaccination, including among those with conditions that place them at high risk for influenza-related complications, such as heart failure. 11 Approximately one-third of patients experience local or systemic vaccine-related adverse reactions in the short-term period following influenza vaccination, .…”