Elsevier

JACC: Heart Failure

Volume 7, Issue 2, February 2019, Pages 112-117
JACC: Heart Failure

Mini-Focus Issue: Cardiac Consequences of Non-Cardiac Disease
Clinical Research
Effect of Influenza on Outcomes in Patients With Heart Failure

https://doi.org/10.1016/j.jchf.2018.10.011Get rights and content
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Abstract

Objectives

This study sought to determine whether influenza infection increases morbidity and mortality in patients hospitalized with heart failure (HF).

Background

Patients with HF may be at increased risk of morbidity and mortality from influenza infection. However, there are limited data for the associated hazards of influenza infection in patients with HF.

Methods

We queried the 2013 to 2014 National Inpatient Sample database for all adult patients (18 years of age or older) admitted with HF with and without concomitant influenza infection. Propensity score matching was used to match patients across age, race, sex, and comorbidities. Outcomes included in-hospital mortality, in-hospital complications, length of stay, and average hospital costs.

Results

Of 8,189,119 all-cause hospitalizations in patients with HF, 54,590 (0.67%) had concomitant influenza infection. Patients with concomitant influenza had higher incidence of in-hospital mortality (6.2% vs. 5.4%, respectively; odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.03 to 1.30]; p = 0.02), acute respiratory failure (36.9% vs. 23.1%, respectively; OR: 1.95 [95% CI: 1.83 to 2.07]; p < 0.001), acute respiratory failure requiring mechanical ventilation (18.2% vs. 11.3%, respectively; OR: 1.75 [95% CI: 1.62 to 1.89]; p < 0.001), acute kidney injury (AKI) (30.3% vs. 28.7%, respectively; OR: 1.08 [95% CI: 1.02 to 1.15]; p = 0.01), and AKI requiring dialysis (2.4% vs. 1.8%, respectively; OR: 1.37 [95% CI: 1.14 to 1.65]; p = 0.001). Patients with influenza had longer mean lengths of stay (5.9 days vs. 5.2 days, respectively; p <0.001) but similar average hospital costs ($12,137 vs. $12,003, respectively; p = 0.40).

Conclusions

Influenza infection is associated with increased in-hospital morbidity and mortality in patients with HF. Our results emphasize the need for efforts to mitigate the incidence of influenza, specifically in this high-risk patient cohort.

Key Words

heart failure
hospitalization
influenza
vaccination

Abbreviations and Acronyms

AKI
acute kidney injury
CI
confidence interval
HF
heart failure
MCS
mechanical circulatory support
OR
odds ratio

Cited by (0)

Dr. Kalra consults for Medtronic and Philips. Dr. Bhatt is on advisory boards of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; serves on the board of directors of Boston VA Research Institute, Society of Cardiovascular Patient Care, and TobeSoft; is chair of American Heart Association Quality Oversight Committee; is on data monitoring committees for Baim Institute for Clinical Research, Cleveland Clinic, Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, and Population Health Research Institute; receives honoraria from American College of Cardiology (Senior Associate Editor, Clinical Trials and News; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research, Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), HMP Global (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute, Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees), Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), and VA CART Research and Publications Committee (Chair); receives research funding from Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi, Synaptic, and The Medicines Company; receives royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); is site co-investigator for Biotronik, Boston Scientific, St. Jude Medical, and Svelte; is a trustee of the American College of Cardiology; performs unfunded research with FlowCo, Merck, Novo Nordisk, PLx Pharma, and Takeda; and serves on the Steering Committee of INVESTED. Dr. Ginwalla is site principal investigator for GALACTIC-HF and PRIME-HF studies; and consults for Xact Labs. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.