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
Comment
. 2024 Jun 1;184(6):602-611.
doi: 10.1001/jamainternmed.2024.0212.

Acute Cardiac Events in Hospitalized Older Adults With Respiratory Syncytial Virus Infection

Rebecca C Woodruff  1 , Michael Melgar  2 , Huong Pham  2 , Laurence S Sperling  1 , Fleetwood Loustalot  1   3 , Pam Daily Kirley  4 , Elizabeth Austin  5 , Kimberly Yousey-Hindes  6 , Kyle P Openo  7   8   9 , Patricia Ryan  10 , Chloe Brown  11 , Ruth Lynfield  12 , Sarah Shrum Davis  13 , Grant Barney  14 , Brenda Tesini  15 , Melissa Sutton  16 , H Keipp Talbot  17 , Hafsa Zahid  18 , Lindsay Kim  3   19 , Fiona P Havers  2   3 ; Respiratory Syncytial Virus Hospitalization Surveillance Network (RSV-NET)
Collaborators, Affiliations
Comment

Acute Cardiac Events in Hospitalized Older Adults With Respiratory Syncytial Virus Infection

Rebecca C Woodruff et al. JAMA Intern Med. .

Abstract

Importance: Respiratory syncytial virus (RSV) infection can cause severe respiratory illness in older adults. Less is known about the cardiac complications of RSV disease compared with those of influenza and SARS-CoV-2 infection.

Objective: To describe the prevalence and severity of acute cardiac events during hospitalizations among adults aged 50 years or older with RSV infection.

Design, setting, and participants: This cross-sectional study analyzed surveillance data from the RSV Hospitalization Surveillance Network, which conducts detailed medical record abstraction among hospitalized patients with RSV infection detected through clinician-directed laboratory testing. Cases of RSV infection in adults aged 50 years or older within 12 states over 5 RSV seasons (annually from 2014-2015 through 2017-2018 and 2022-2023) were examined to estimate the weighted period prevalence and 95% CIs of acute cardiac events.

Exposures: Acute cardiac events, identified by International Classification of Diseases, 9th Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification discharge codes, and discharge summary review.

Main outcomes and measures: Severe disease outcomes, including intensive care unit (ICU) admission, receipt of invasive mechanical ventilation, or in-hospital death. Adjusted risk ratios (ARR) were calculated to compare severe outcomes among patients with and without acute cardiac events.

Results: The study included 6248 hospitalized adults (median [IQR] age, 72.7 [63.0-82.3] years; 59.6% female; 56.4% with underlying cardiovascular disease) with laboratory-confirmed RSV infection. The weighted estimated prevalence of experiencing a cardiac event was 22.4% (95% CI, 21.0%-23.7%). The weighted estimated prevalence was 15.8% (95% CI, 14.6%-17.0%) for acute heart failure, 7.5% (95% CI, 6.8%-8.3%) for acute ischemic heart disease, 1.3% (95% CI, 1.0%-1.7%) for hypertensive crisis, 1.1% (95% CI, 0.8%-1.4%) for ventricular tachycardia, and 0.6% (95% CI, 0.4%-0.8%) for cardiogenic shock. Adults with underlying cardiovascular disease had a greater risk of experiencing an acute cardiac event relative to those who did not (33.0% vs 8.5%; ARR, 3.51; 95% CI, 2.85-4.32). Among all hospitalized adults with RSV infection, 18.6% required ICU admission and 4.9% died during hospitalization. Compared with patients without an acute cardiac event, those who experienced an acute cardiac event had a greater risk of ICU admission (25.8% vs 16.5%; ARR, 1.54; 95% CI, 1.23-1.93) and in-hospital death (8.1% vs 4.0%; ARR, 1.77; 95% CI, 1.36-2.31).

Conclusions and relevance: In this cross-sectional study over 5 RSV seasons, nearly one-quarter of hospitalized adults aged 50 years or older with RSV infection experienced an acute cardiac event (most frequently acute heart failure), including 1 in 12 adults (8.5%) with no documented underlying cardiovascular disease. The risk of severe outcomes was nearly twice as high in patients with acute cardiac events compared with patients who did not experience an acute cardiac event. These findings clarify the baseline epidemiology of potential cardiac complications of RSV infection prior to RSV vaccine availability.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Ms Kirley reported receiving funding from the Centers for Disease Control and Prevention (CDC) during the conduct of the study. Ms Austin reported receiving funding from the CDC during the conduct of the study. Ms Yousey-Hindes reported receiving a grant from The Connecticut Emerging Infections Program during the conduct of the study. Dr Openo reported receiving funding from the CDC during the conduct of the study. Dr Ryan reported institutional support from the CDC during the conduct of the study. Ms Brown reported receiving a grant from the Michigan Department of Health and Human Services during the conduct of the study. Dr Lynfield reported receiving a grant from the CDC Emerging Infections Program paid to the Minnesota Department of Health during the conduct of the study and serving as Associate Editor for the American Academy of Pediatrics Red Book–Report of the Committee on Infectious Diseases. Ms Shrum Davis reported receiving a grant from the CDC’s Emerging Infections Program during the conduct of the study. Mr Barney reported receiving funding from the CDC during the conduct of the study. Dr Tesini reported receiving a grant from the CDC during the conduct of the study and personal fees from Merck outside the submitted work. Dr Sutton reported receiving a grant from the CDC’s Emerging Infections Program during the conduct of the study. Dr Talbot reported receiving a grant from the CDC during the conduct of the study. Ms Zahid reported receiving funding from the CDC during the conduct of the study. No other disclosures were reported.

Comment on

References

    1. Branche AR, Saiman L, Walsh EE, et al. . Change in functional status associated with respiratory syncytial virus infection in hospitalized older adults. Influenza Other Respir Viruses. 2022;16(6):1151-1160. doi:10.1111/irv.13043 - DOI - PMC - PubMed
    1. Wyffels V, Kariburyo F, Gavart S, Fleischhackl R, Yuce H. A real-world analysis of patient characteristics and predictors of hospitalization among US Medicare beneficiaries with respiratory syncytial virus infection. Adv Ther. 2020;37(3):1203-1217. doi:10.1007/s12325-020-01230-3 - DOI - PMC - PubMed
    1. Kujawski SA, Whitaker M, Ritchey MD, et al. . Rates of respiratory syncytial virus (RSV)–associated hospitalization among adults with congestive heart failure—United States, 2015-2017. PLoS One. 2022;17(3):e0264890. doi:10.1371/journal.pone.0264890 - DOI - PMC - PubMed
    1. McLaughlin JM, Khan F, Begier E, Swerdlow DL, Jodar L, Falsey AR. Rates of medically attended RSV among US adults: a systematic review and meta-analysis. Open Forum Infect Dis. 2022;9(7):ofac300. doi:10.1093/ofid/ofac300 - DOI - PMC - PubMed
    1. Prasad N, Walker TA, Waite B, et al. . Respiratory syncytial virus–associated hospitalizations among adults with chronic medical conditions. Clin Infect Dis. 2021;73(1):e158-e163. doi:10.1093/cid/ciaa730 - DOI - PubMed