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Effect of flu vaccination on severity and outcome of heart failure decompensations

      Three bullet points

      • Heart failure is a very prevalent condition in people over 65 years old and therefore, it is important to investigate the factors that are involved in increasing both morbidity and mortality.
      • In the era of vaccination in which we find ourselves, it is important to continuously try to show the protective effect of this medical tool. In this case, not only in patients with chronic heart failure, also in those with acute heart failure.
      • Spending time researching which methods can protect our patients that suffer from heart failure, makes us having more possibilities to improve their life expectancy and quality.

      Abstract

      Objective: To investigate the relationship of seasonal flu vaccination with severity of decompensations and long-term outcomes of patients with heart failure (HF).
      Methods: We analyzed 6,147 consecutively enrolled decompensated HF patients who presented to 33 Spanish emergency departments (EDs) during January and February, 2018 and 2019, grouped according to seasonal flu vaccination status. Severity of HF decompensation was assessed with the MEESSI scale, need of hospitalization, and in-hospital all-cause mortality. Long-term outcomes analyzed were 90-day post-discharge adverse events and 90-day all-cause death. Associations between vaccination, HF decompensation severity, and long-term outcomes were explored by unadjusted and adjusted logistic and Cox regressions using 14 covariables that could act as potential confounders.
      Results: Overall median (IQR) age was 84 (IQR=77-89) years, 56% were women. Vaccinated patients (n=1,139, 19%) were older, with more comorbidities, and with worse baseline status assessed by NYHA class and Barthel index, than unvaccinated patients (n=5,008, 81%). Infection triggering decompensation was more frequent in vaccinated patients (50% versus 41%, p<0.001). In vaccinated and unvaccinated patients, high or very-high risk decompensation was seen in 21.9% and 21.1%, hospitalization occurred in 72.5% and 73.7%, in-hospital mortality was 7.4% and 7.0%, 90-day post-discharge adverse events were 57.4% and 53.2%, and 90-day mortality was 15.8% and 16.6%, respectively, with no significant differences between cohorts. After adjusting, vaccinated decompensated HF patients had a decreased odds for hospitalization (OR=0.823, 95%CI=0.709-0.955).
      Conclusion: In HF patients, seasonal flu vaccination is associated with less severe decompensations.

      Graphical Abstract

      Key words

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