Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2013 Dec;99(24):1843-8.
doi: 10.1136/heartjnl-2013-304320. Epub 2013 Aug 21.

Ischaemic heart disease, influenza and influenza vaccination: a prospective case control study

C Raina Macintyre  1 , Anita E Heywood, Pramesh Kovoor, Iman Ridda, Holly Seale, Timothy Tan, Zhanhai Gao, Anthea L Katelaris, Ho Wai Derrick Siu, Vincent Lo, Richard Lindley, Dominic E Dwyer
Affiliations
Free PMC article
Comparative Study

Ischaemic heart disease, influenza and influenza vaccination: a prospective case control study

C Raina Macintyre et al. Heart. 2013 Dec.
Free PMC article

Abstract

Background: Abundant, indirect epidemiological evidence indicates that influenza contributes to all-cause mortality and cardiovascular hospitalisations with studies showing increases in acute myocardial infarction (AMI) and death during the influenza season.

Objective: To investigate whether influenza is a significant and unrecognised underlying precipitant of AMI.

Design: Case-control study.

Setting: Tertiary referral hospital in Sydney, Australia, during 2008 to 2010.

Patients: Cases were inpatients with AMI and controls were outpatients without AMI at a hospital in Sydney, Australia.

Main outcome measures: Primary outcome was laboratory evidence of influenza. Secondary outcome was baseline self-reported acute respiratory tract infection.

Results: Of 559 participants, 34/275 (12.4%) cases and 19/284 (6.7%) controls had influenza (OR 1.97, 95% CI 1.09 to 3.54); half were vaccinated. None were recognised as having influenza during their clinical encounter. After adjustment, influenza infection was no longer a significant predictor of recent AMI. However, influenza vaccination was significantly protective (OR 0.55, 95% CI 0.35 to 0.85), with a vaccine effectiveness of 45% (95% CI 15% to 65%).

Conclusions: Recent influenza infection was an unrecognised comorbidity in almost 10% of hospital patients. Influenza did not predict AMI, but vaccination was significantly protective but underused. The potential population health impact of influenza vaccination, particularly in the age group 50-64 years, who are at risk for AMI but not targeted for vaccination, should be further explored. Our data should inform vaccination policy and cardiologists should be aware of missed opportunities to vaccinate individuals with ischaemic heart disease against influenza.

Keywords: Coronary Artery Disease; Infection.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Consort diagram of recruitment and follow-up.
See this image and copyright information in PMC

Comment in

References

    1. Nielsen J, Mazick A, Glismann S, et al. Excess mortality related to seasonal influenza and extreme temperatures in Denmark, 1994–2010. BMC Infect Dis 2011;11:350. - PMC - PubMed
    1. Chiu C, Dey A, Wang H, et al. Vaccine preventable diseases in Australia, 2005 to 2007. Commun Dis Intell 2010;34(Supp):S1–167 - PubMed
    1. Fiore AE, Uyeki TM, Broder K, et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep 2010;59:1–62 - PubMed
    1. Reichert TA, Simonsen L, Sharma A, et al. Influenza and the winter increase in mortality in the United States, 1959–1999. Am J Epidemiol 2004;160:492–502 - PubMed
    1. Newall AT, Wood JG, Macintyre CR. Influenza-related hospitalisation and death in Australians aged 50 years and older. Vaccine 2008;26:2135–41 - PMC - PubMed

Publication types

MeSH terms

Substances