Elsevier

American Heart Journal

Volume 244, February 2022, Pages 50-53
American Heart Journal

Research Letters
Influenza vaccination among adults with cardiovascular disease in the United States: Results from the Behavioral Risk Factor Surveillance System 2018–2019

https://doi.org/10.1016/j.ahj.2021.09.004Get rights and content

Influenza causes significant morbidity and mortality among adults with cardiovascular disease (CVD). In nationally representative surveys of 101,210 individuals with CVD conducted in 2018 and 2019, the self-reported rate of vaccination was only 50%, with significant disparities by race and education. We advocate that cardiologists not only routinely emphasize vaccination but capitalize on the opportunity to vaccinate patients at office visits to improve overall rates of vaccination and their associated racial disparities.

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Background

On the basis of the 2017 National Health Interview Survey, the age-adjusted prevalence of all types of heart disease was 10.6%.1 Although acute and chronic therapy for cardiovascular disease (CVD) have improved in recent years, individuals with prevalent CVD remain at high risk for acute, potentially fatal superimposed events. Acute infection with influenza increases both cardiovascular and all-cause mortality.2,3 In one study of 80,261 patients hospitalized with influenza, 11.7% had an acute

Data source

We analyzed the 2018 to 2019 iterations of the Behavioral Risk Factor Surveillance System (BRFSS) conducted by the Centers for Disease Control and Prevention (CDC) in all 50 states, the District of Columbia, and US territories. This ongoing annual telephone survey measures behavioral risk factors in adults (≥18 years of age) in the US. A random sample of adults (one per household) are surveyed through a yearly telephone survey conducted by state health personnel or contractors, and it is

Results

A total of 101,210 individuals, corresponding to approximately 21 million Americans, reported having CVD in the form of angina, coronary heart disease, or stroke. In this population, only 50.4% (95% CI: 49.7-51.1) received an influenza vaccine within the past year.

In mutually adjusted analyses, we observed no difference by sex (OR for men vs women 0.98, 95% CI: 0.91-1.03, P = .65). Adults ≥65 years of age were more like to report vaccination than those <65 (OR 2.29, 95% CI: 2.15-2.42, P < .01).

Discussion

Despite recommendations for universal influenza vaccination for patients with CVD by the ACC/AHA and Centers for Disease Control and Prevention, influenza vaccination among individuals with clinician diagnosed CVD in the US is poor, with only half of this population reporting up-to-date vaccination in 2018 to 2019.5,10 Ensuring vaccination status is of rising importance, as recent data suggest that vaccination is associated with a lower risk of acute heart failure and acute ischemic heart

Conclusion

Only 50% of the US population with CVD reported up-to-date influenza vaccination despite its proven benefit in this population. Rates are particularly low among underserved minorities. To improve this gap, cardiologists should consider incorporating influenza vaccination into routine cardiovascular care (Table I, Table II).

Funding

This work was supported by the National Institute on Aging (K24AG065525).

Conflict of interest

The authors report no relationships relevant to the contents of this paper to disclose. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents.

Acknowledgments

Dr Mukamal is supported by the National Institute on Aging (K24AG065525). This work was presented as a short abstract at the 2021 American College of Cardiology 70th Annual Scientific Session.

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