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. 2023 Aug 7;9(5):474-481.
doi: 10.1093/ehjqcco/qcac049.

Seasonal influenza vaccine uptake among patients with cardiovascular disease in Denmark, 2017-2019

Daniel Mølager Christensen  1   2 , Sidsel Marie Bernt Jørgensen  1 , Mohamad El-Chouli  1 , Matthew Phelps  1 , Anne-Marie Schjerning  1   3 , Thomas S G Sehested  1   3 , Thomas Gerds  1   4 , Caroline Sindet-Pedersen  5 , Tor Biering-Sørensen  5   6 , Christian Torp-Pedersen  7   8 , Morten Schou  5 , Gunnar Gislason  1   5   9
Affiliations

Seasonal influenza vaccine uptake among patients with cardiovascular disease in Denmark, 2017-2019

Daniel Mølager Christensen et al. Eur Heart J Qual Care Clin Outcomes. .

Abstract

Background: Influenza vaccination protects against morbidity and mortality in patients with cardiovascular disease (CVD). We aimed to describe influenza vaccine uptake in patients with CVD in a universal-access healthcare system.

Methods: Using nationwide Danish registries, we included all patients with prevalent CVD, defined as heart failure (HF), atrial fibrillation (AF), ischemic heart disease (IHD), or stroke during three consecutive influenza seasons (October-December 2017-2019). The outcome was relative frequency of influenza vaccination across strata of patient characteristics.

Results: There was an average of 397 346 patients with CVD yearly during 2017-2019. Vaccine uptake was 45.6% for the whole population and ranged from 55.0% in AF to 61.8% in HF among patients aged ≥65 years. Among patients aged <65 years, uptake was 32.6% in HF, 19.0% in AF, 21.1% in IHD, and 18.3% in stroke. There was a lower uptake with decreasing age: 21.6% in HF, 5.5% in AF, 7.4% in IHD, and 6.3% in stroke among males aged <45 years, as opposed to 25.5% in HF, 11.5% in AF, 13.8% in IHD, and 12.1% in stroke for males aged 45-54 years. In the further stratified analyses, uptake ranged from a low of 2.5% for males <45 years with AF who were not vaccinated the previous season to a high of 87.0% for females ≥75 years with IHD who were vaccinated the previous season.

Conclusion: Seasonal influenza vaccine uptake is suboptimal among patients with CVD, even in a universal-access healthcare system with free-of-charge vaccinations. Vaccine uptake was particularly low among young patients.

Keywords: Cardiovascular; Influenza; Registry; Vaccine.

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Conflict of interest statement

Dr Tor Biering-Sørensen reports the following: Steering Committee member of the Amgen financed GALACTIC-HF trial; Chief investigator and steering committee chair of the Sanofi Pasteur financed ‘NUDGE-FLU’ trial; Chief investigator and steering committee chair of the Sanofi Pasteur financed ‘DANFLU-1’ trial; Chief investigator and steering committee chair of the Sanofi Pasteur financed ‘DANFLU-2’ trial; Steering Committee member of ‘LUX-Dx TRENDS Evaluates Diagnostics Sensors in Heart Failure Patients Receiving Boston Scientific's Investigational ICM System’ trial; Advisory Board: Sanofi Pasteur, Amgen and GSK; Speaker Honorarium: Novartis, Sanofi Pasteur and GSK; Research grants: GE Healthcare and Sanofi Pasteur. Dr Christian Torp-Pedersen reports the following: Grants for studies from Bayer and Novo Nordisk unrelated to the current study. Dr Schou reports lecture fees from Novo Nordisk, Astra Zeneca, Novartis, and Boehringer Ingelheim outside the current study. All other authors had no conflicts of interest to disclose.

Figures

Graphical Abstract
Graphical Abstract
Overview of study design and key findings.
Figure 1
Figure 1
Influenza vaccine uptake in patients above and below 65 years with prevalent heart failure, atrial fibrillation, ischemic heart disease, or atrial fibrillation. The dashed line represents the overall vaccine uptake in the study population. Each individual patient could have multiple cardiovascular diseases, thus contributing to more than one group.
Figure 2
Figure 2
Heatmap of influenza vaccine uptake stratified by age and sex in patients with prevalent heart failure, atrial fibrillation, ischemic heart disease, or stroke. HF, heart failure; AF, atrial fibrillation, IHD, ischemic heart disease.
Figure 3
Figure 3
Heatmap of influenza vaccine uptake stratified by cardiovascular disease, age, sex, and vaccination status for the previous season, comorbidity status, civil status, or educational level. Vacc., vaccination; CV, cardiovascular; HF, heart failure; AF, atrial fibrillation; IHD, ischemic heart disease.
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