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
Observational Study
. 2022 Aug;37(10):2405-2412.
doi: 10.1007/s11606-021-07068-x. Epub 2021 Aug 11.

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

Matthew T Mefford  1 , Ran Liu  2 , Katia Bruxvoort  2 , Lei Qian  2 , Jonathan M Doris  3 , Sandra Y Koyama  4 , Hung Fu Tseng  2 , Kristi Reynolds  2
Affiliations
Observational Study

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

Matthew T Mefford et al. J Gen Intern Med. 2022 Aug.

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 all-cause hospitalization (HR 1.27, 95% CI 1.21, 1.31). There was no association between influenza vaccination and all-cause or cardiovascular mortality during the non-influenza 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.

Keywords: cardiovascular disease; epidemiology; heart failure; mortality.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

References

    1. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56–e528. doi: 10.1161/CIR.0000000000000659. - DOI - PubMed
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137–e61. doi: 10.1161/CIR.0000000000000509. - DOI - PubMed
    1. DeVore AD, Bhatt AS. Influenza Vaccination in Patients With Heart Failure. Circulation. 2019;139(5):587–9. doi: 10.1161/CIRCULATIONAHA.118.038348. - DOI - PubMed
    1. Alon D, Stein GY, Korenfeld R, Fuchs S. Predictors and outcomes of infection-related hospital admissions of heart failure patients. PLoS One. 2013;8(8):e72476. doi: 10.1371/journal.pone.0072476. - DOI - PMC - PubMed
    1. Bhatt AS, Liang L, DeVore AD, Fonarow GC, Solomon SD, Vardeny O, et al. Vaccination Trends in Patients With Heart Failure: Insights From Get With The Guidelines-Heart Failure. JACC Heart Fail. 2018;6(10):844–55. doi: 10.1016/j.jchf.2018.04.012. - DOI - PubMed

Publication types

Substances