Bullet Points
- •Heart failure is a very prevalent condition in people older than 65 years and, therefore, it is important to investigate the factors that are involved in the increase of both morbidity and mortality.
- •In the era of vaccination in which we find ourselves, it is important to try continuously to show the protective effects of this medical tool, in this case, not only in patients with chronic heart failure but also in those with acute heart failure.
- •Spending time researching the methods can protect our patients who suffer from heart failure gives us more possibilities for improving their quality of life and their life expectancy.
ABSTRACT
Objective
To investigate the relationship of seasonal flu vaccination with the severity of decompensation
and long-term outcomes of patients with heart failure (HF).
Methods
We analyzed 6147 consecutively enrolled patients with decompensated HF who presented
to 33 Spanish emergency departments (EDs) during January and February of 2018 and
2019, grouped according to seasonal flu vaccination status. The severity of HF decompensation
was assessed by the Multiple Estimation of Risk Based on the Emergency Department
Spanish Score in Patients With Acute Heart Failure (MEESSI-AHF) + MEESSI scale, need
of hospitalization and in-hospital all-cause mortality. The long-term outcomes analyzed
were 90-day postdischarge 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 by using 14 covariables that
could act as potential confounders.
Results
Overall median (IQR) age was 84 (IQR = 77-89) years, and 56% were women. Vaccinated
patients (n = 1139; 19%) were older, had more comorbidities and had worse baseline
status, as assessed by New York Heart Association class and Barthel index, than did
unvaccinated patients (n = 5008; 81%). Infection triggering decompensation was more
common in vaccinated patients (50% vs 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 postdischarge adverse events were 57.4% and 53.2%;
and the 90-day mortality rate was 15.8% and 16.6%, respectively, with no significant
differences between cohorts. After adjusting, vaccinated decompensated patients with
HF had decreased odds for hospitalization (OR = 0.823, 95%CI = 0.709–0.955).
Conclusion
In patients with HF, seasonal flu vaccination is associated with less severe decompensations.
Graphical Abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: January 24, 2023
Accepted:
December 28,
2022
Received in revised form:
December 22,
2022
Received:
June 17,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
