Congestive Heart Failure Significantly Increases Risk of RSV Hospitalization

Adults with congestive heart failure (CHF) have more than an 8-fold increased risk of hospitalization associated with respiratory syncytial virus (RSV), according to findings from a new study.

The new data, presented by a team of Centers for Disease Control and Prevention (CDC) investigators, additionally show a positive correlation between patient age, prevalence of CHF, and risk of hospitalization due to the common lower respiratory tract disease.

Previous research has linked RSV infection to hospitalizations and deaths among adults with previous cardiopulmonary conditions, but most available data examining the link between RSV and such diseases has focused on only older adult populations. As research continues into potential RSV vaccines and monoclonal antibody drugs, the CDC investigators sought to better interpret potential high-risk populations for RSV infection.

Led by Stephanie A. Kujawski, PharmD of the CDC National Center for Immunization and Respiratory Diseases, investigators sought to quantify the rate of RSV infection among hospitalized adults based on CHF status and their age.

The team used CDC RSV surveillance data from the Emerging Infections Program’s RSV-NET network. They conducted surveillance over 2 respiratory seasons from 2015 to 2017 at 7 sites across the US. Eligible patients were adults ≥18 years old admitted to a catchment area hospital with laboratory-confirmed RSV within 14 days of admission or at any time during their hospitalization.

Patient demographic and clinical information, including CHF prevalence, was derived from medical records.

The team identified 2204 hospitalized RSV cases in the observed clinics; 2042 (92.6%) had recorded CHF status. Among those patients, 1230 (60.2%) were ≥65 years old and 1208 (59.2%) were female.

Median hospital stay duration among patients with RSV and CHF was 4 days (IQR, 3-7); 20.3% of patients were admitted to the intensive care unit (ICU) during their stay, and 4.9% (n = 101) died during hospitalization.

CHF was observed in nearly 3 of every 10 hospitalized RSV patients (28.3% [n = 557]); approximately three-quarters (73.5%) of these patients were ≥65 years old. Hospitalized patients with RSV and CHF were more likely to have chronic obstructive pulmonary disease (COPD) (39.9% vs 29.1%; P <.001) and be either obese or morbidly obese (41.6% vs 34.5%) than hospitalized RSV patients without CHF.

Patients with both conditions were also more likely to be admitted to the ICU; more than twice the rate of adults with both RSV and CHF died during hospitalization than those with lone RSV (7.8% vs 3.8%; P <.001).

Adults with CHF had 8.1 times greater rates of RSV hospitalizations than adults without CHF (95% CI, 6.8 – 9.7). Adults ≥65 years old with CHF were 3.5 times more likely to be hospitalized with RSV than adults without CHF (95% CI, 3-.1 – 4.0). Among adults <65 years old with CHF, the RSV rate was 14.3 times greater (95% CI, 11.8 – 17.3).

Investigators noted this is among the first trials to calculate the rate of RSV hospitalization in all adults based on CHF status. Though it was limited by factors including the means of RSV detection and CHF diagnoses, they found the high rates of RSV hospitalization among patients with CHF to indicate a need for redefining the effect of RSV on at-risk cardiac patients—and the potential impact vaccines and treatments may have.

“RSV should be considered as a cause of acute respiratory illness and as potentially contributing to CHF exacerbations in adults during the respiratory season,” they concluded. “More research is needed on the role of RSV in acute exacerbations of CHF and the impact on long-term health outcomes.”

The study, “Rates of respiratory syncytial virus (RSV)-associated hospitalization among adults with congestive heart failure—United States, 2015–2017,” was published online in PLOS One.