The Effect of Influenza Vaccination on Mortality and Risk of Hospitalization in Patients With Heart Failure: A Systematic Review and Meta-analysis

Abstract

Background Influenza is a major cause of morbidity and mortality in patients diagnosed with heart failure. The aim of this study was to evaluate the effectiveness of influenza vaccination in this population in terms of reduction in all-cause mortality and rate of hospitalization. Methods We conducted a systematic review and meta-analysis using PubMed and EMBASE entries from January of 2000 through April 2018. Publication bias was examined using the Egger’s regression test. Statistical heterogeneity was examined using the Higgins I 2 statistic. Subgroup analyses were performed to examine the effect of vaccination during the influenza and noninfluenza seasons. Results We identified 8 studies that included a total of 82 354 patients with heart failure. In patients with heart failure who were vaccinated against influenza, we found a reduced risk of all-cause mortality (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.51–0.87). No evidence of publication bias was found, and the effect was more pronounced during influenza season (HR, 0.49; 95% CI, 0.30–0.69), compared with noninfluenza season (HR, 0.79; 95% CI, 0.68–0.89). In terms of heart failure hospitalizations, we did not identify a statistically significant difference between the cohorts (HR, 0.62; 95% CI, 0.00–1.23). Conclusions Influenza vaccination was associated with a decreased risk of all-cause mortality in patients with heart failure, and this effect was more prominent during the influenza season.

A comparison of epidemiology and clinical outcomes between influenza A H1N1pdm09 and H3N2 based on multicenter surveillance from 2014 to 2018 in South Korea

“…25 Recently, an analysis of high-risk individuals with chronic obstructive pulmonary disease or heart failure showed a benefit of all-cause mortality in the influenza vaccinated group. 26,27 This finding is comparable to our result because all hospitalized participants in our analysis had more than one underlying illness. Moreover, South Korea has a relatively well-organized immunization program with a high vaccination rate;…”

“…However, there is a controversy regarding whether the vaccine can certainly reduce mortality 25 . Recently, an analysis of high‐risk individuals with chronic obstructive pulmonary disease or heart failure showed a benefit of all‐cause mortality in the influenza vaccinated group 26,27 . This finding is comparable to our result because all hospitalized participants in our analysis had more than one underlying illness.…”

Epidemic situation of the complex seasonality of imported influenza A and B virus transmission in Guangxi ports of China

“…Influenza A and B fluctuated simultaneously or alternately. This was consistent with the global influenza trend in recent years and the local influenza situation [15][16][17]. Influenza A and B viruses can infect people of different ages, and children and adolescents were high-risk people with influenza A or B virus infection [18].…”

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

“…11 A systematic review and meta-analysis of 82,354 patients with HF across 8 studies, influenza vaccination was associated with a 31% lower risk of 1-year all-cause mortality. 26 In a Danish nationwide cohort study with 99.8% follow-up, Modin and colleagues reported a 19% lower risk of mortality for vaccinated vs unvaccinated adults with HF. 12 In the current study, we observed a 34% lower risk of all-cause mortality in multivariable-adjusted analyses; a similar risk reduction was observed for cardiovascular mortality.…”