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Acute CV Events in Hospitalized Older Adults With RSV
Quick Takes
- Nearly one-quarter of adults aged ≥50 years with respiratory syncytial virus (RSV) infection experienced an acute cardiac event.
- 8.5% of the adults with RSV who did not have underlying cardiac disease experienced an acute cardiac event. Those who experienced an acute cardiac event had a greater risk of ICU admission and in-hospital death.
Study Questions:
What is the frequency and severity of acute cardiac events among hospitalized adults aged ≥50 years with respiratory syncytial virus (RSV)?
Methods:
A cross-sectional study was conducted by the RSV Hospitalization Surveillance Network (RSV-NET), which is one of the Centers for Disease Control and Prevention (CDC). RSV-NET conducts population-based surveillance of patients who are hospitalized for RSV infections. The cases were from 58 counties in 12 geographically diverse US states. Clinical information of all adult RSV-NET cases was collected between 2014–2015 and the 2017–2018 annual RSV season. Detailed clinical data were abstracted that included demographic characteristics, underlying medical conditions, clinical characteristics, in-hospital interventions and outcomes, discharge diagnoses listed in the discharge summary, and the first 9th and 10th International Classification of Diseases (ICD-9 and ICD-10) discharge codes.
Results:
The study included 6,248 hospitalized adults (median age, 72.7 [63.0-82.3] years; 59.6% female; 56.4% with underlying cardiovascular disease [CVD]) with laboratory confirmed RSV infection. The weighted estimated prevalence of experiencing a cardiac event was 22.4% (95% confidence interval [CI], 21.0%-23.7%). The weighted estimated prevalence was 15.8% (95% CI, 14.6%-17.0%) for acute heart failure, 7.5% (95% CI, 6.8%-8.3%) for acute ischemic heart disease, 1.3% (95% CI, 1.0%-1.7%) for hypertensive crisis, 1.1% (95% CI, 0.8%-1.4%) for ventricular tachycardia, and 0.6% (95% CI, 0.4%-0.8%) for cardiogenic shock. Adults with underlying CVD had a greater risk of experiencing an acute cardiac event relative to those who did not (33.0% vs. 8.5%; adjusted risk ratio [ARR], 3.51; 95% CI, 2.85-4.32). Among all hospitalized adults with RSV infection, 18.6% required intensive care unit (ICU) admission and 4.9% died during hospitalization. Compared with patients without an acute cardiac event, those who experienced an acute cardiac event had a greater risk of ICU admission (25.8% vs. 16.5%; ARR, 1.54; 95% CI, 1.23-1.93) and in-hospital death (8.1% vs. 4.0%; ARR, 1.77; 95% CI, 1.36-2.31).
Conclusions:
Study findings suggest that acute cardiac events are common among hospitalized older adults with RSV infections and are associated with severe clinical outcomes, including in-hospital death.
Perspective:
Based on the results of this study, health care providers need to be aware of the increased risk for adverse outcomes in adult patients 50 years and older who are hospitalized with RSV. To address vaccination hesitance, patients and providers need to be educated on the risks of adverse outcomes from viruses that historically were considered dangerous only in the infant and pediatric populations. Expanding the recommendation for RSV vaccination for people aged ≥50 years should be considered.
Clinical Topics: Acute Coronary Syndromes, Prevention
Keywords: Acute Coronary Syndrome, Respiratory Syncytial Virus Infections
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