'ACC Recommends Vaccination Against Respiratory Illness in Cardiovascular Disease'

 Adults with heart disease should get vaccinated against a range of respiratory viruses, according to new clinical guidance from the American College of Cardiology.

The recommendation, published this week in the Journal of the American College of Cardiology, recommends people with cardiovascular disease receive vaccines against influenza, COVID-19, and respiratory syncytial virus (RSV), as this population is at greater risk for respiratory infections and subsequent adverse events, including hospitalization and death. The guidance also recommends other vaccines, such as those against shingles and pneumococcal disease, where vaccination appears to offer cardiovascular protection.

For a person with cardiovascular disease, a respiratory illness can put strain on the heart, according to Srihari S. Naidu, MD, a professor of medicine in the Division of Cardiology at New York Medical College in Valhalla, New York, who was not a part of the guidelines committee.

“In an older person, the heart has to work harder and beat faster,” Naidu said, adding that this can be detrimental to someone with heart problems. “This can cause shortness of breath or chest pain and may lead to hospitalization or death.” 

A vaccination will not always prevent a respiratory infection but it will make it less severe, he added.

The European Society of Cardiology has also recognized the importance of vaccination against respiratory disease as part of cardiovascular risk management. A consensus statement released earlier this year by the group called for vaccinations to be “considered the fourth pillar” of medical prevention of cardiovascular disease, alongside antihypertensives, lipid-lowering agents and drugs that treat diabetes.

The authors of the statement noted that data from the Atherosclerosis Risk in Communities study showed that each 5% increase in monthly influenza activity was linked with a 24% increase in hospitalization rates for heart failure. SARS-CoV-2 was also associated with a significant rise in the risk for cardiovascular disease, particularly early in the COVID-19 pandemic when population immunity was extremely low, according to the National Institutes of Health. Other respiratory infections, including RSV, parainfluenza, adenovirus, and pneumococcal pneumonia, have also been tied to increased morbidity and mortality from cardiovascular conditions.

Vaccine Uptake Suboptimal in the US

In the US, overall rates of vaccination remain suboptimal, according to data from the National Foundation for Infectious Diseases Immunization Survey. The cumulative proportion of adults vaccinated in 2024 was < 50% for the influenza vaccine and < 25% for both the COVID-19 and RSV vaccines.

The FDA recently approved updated formulations of the three currently available COVID-19 vaccines from Pfizer/BioNTech, Moderna, and Novavax, albeit with narrower indications. On August 27, Robert F. Kennedy Jr, secretary of Health and Human Services, announced on the social media platform X that the emergency use authorizations for the vaccines have been removed, but they have been approved for people with conditions, such as cardiovascular disease, that increase their risk for severe outcomes from COVID-19.

The new guidelines acknowledge several barriers to vaccination and outline strategies to overcome issues related to access, address vaccine hesitancy, and improve vaccination rates. Cardiology visits provide an ideal opportunity for clinicians to educate patients, the authors stated.

One key barrier to getting vaccinated is the lack of patient knowledge about the link between heart disease and avoiding vaccinations, said Paul Heidenreich, MD, professor and vice chair for quality in the Department of Medicine at Stanford University in Stanford, California, and lead author of the clinical guidance.

“Many patients do not realize that their heart condition puts them at risk for more severe lung and heart disease should they become infected,” Heidenreich said. “Heart disease is often due in part to inflammation that may be systemic and this inflammation may worsen lung function.” 

According to the American Heart Association, research on the impact of respiratory illnesses and heart disease shows:

• About 20% of adults hospitalized with RSV experienced heart attacks and heart failure.
• COVID-19 is associated with a greater risk for heart failure, irregular heartbeat, and coronary disease.
• The risk for a heart attack may be up to six times higher in the week following an influenza diagnosis.

Another barrier to vaccination is that many specialty care clinics are not structured to provide vaccinations, Heidenreich added.

“Providing a vaccine may be seen [as something] that is outside of the normal duties of staff,” he said. “If copays are imposed, some patients will no longer agree to vaccination. Fortunately, health plans are still required to provide certain vaccines free of charge.”

Heidenreich and Naidu reported no relevant financial conflicts of interest.

https://www.medscape.com/viewarticle/acc-recommends-vaccination-against-respiratory-illness-2025a1000mph