Flu Vaccine Associated With Lower Mortality for Patients With Heart Failure

Hidekatsu Fukuta, MD

Getting a season influenza (or flu) vaccine can reduce the risk of death during flu season, but recent data has revealed that for patients with heart failure (HF), that reduction can be up to 50% in season and 20% out of season.

Presented at the 67^th American College of Cardiology Scientific Sessions in Orlando, Florida, the data are a welcome sign, especially at a time where the flu season is garnering lots of hype in the media. While the 2017-2018 flu season has been bad, Director of the National Institute of Allergy and Infectious Diseases Anthony Fauci, MD, told MD Magazine, “Though the perception has been ‘Wow, this is unprecedented,’ in no way is it unprecedented.”

Although, death during the flu season is a serious possibility for patients with HF—about 6.5 million Americans—as lead study author Hidekatsu Fukuta, MD, a cardiologist at Nagoya City University Graduate School of Medical Sciences in Nagoya, Japan noted.

“It is well known that influenza infection is associated with increased risk for mortality in heart failure patients,” he said in a statement. “Given the high mortality rate and the relatively low influenza vaccination rates in heart failure patients worldwide, our study supports a wider use of influenza vaccination in heart failure patients.”

Fukuta and colleagues analyzed 6 studies—5 observational and 1 retrospective analysis—from the United States, Europe, and Asia, including data from more than 78,000 patients with heart failure. There were no randomized control trials available that were designed to examine the flu vaccine in patients with HF.

Overall, the risk of all-cause mortality for patients with HF was reduced by almost 50% (risk ratio, 0.52; 95% CI, 0.39-0.69) during flu season, by roughly 20% (risk ratio, 0.79; 95% CI, 0.69-0.90), and a lower risk of hospitalization from cardiovascular conditions (risk ratio, 0.78; 95% CI, 0.68-0.89).

The 6 studies revealed that 26% to 86% of patients with HF had been vaccinated, a variability that the researchers explained may be due to limited available guideline recommendations for the vaccine in this patient population.

The Heart Failure Society of America recommends annual influenza vaccination in all heart failure patients who do not have known contraindications, but the ACC/AHA and European Society of Cardiology guidelines do not make recommendations for heart failure patients. The Centers for Disease Control and Prevention recommends that everyone age 6 months and older get a flu shot yearly and encourages those with HF to stay up to date on immunizations as well.

"Randomized controlled studies should be planned to confirm our observed potential survival benefit of influenza vaccination in these patients," Fukuta said.

The study, “The effect of influenza vaccination on mortality and hospitalization in patients with heart failure: a meta-analysis,” was published in the Journal of the American College of Cardiology.