This post was authored by Carolyn B. Bridges, MD, associate director for Adult Immunizations, Immunization Services Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention.

As cardiovascular care team members, you treat patients who have an urgent need for influenza vaccine. People with chronic cardiovascular disease are at high risk for developing serious complications from influenza infection. In fact, among adults hospitalized with laboratory-confirmed influenza, cardiovascular disease is the most common chronic condition. During the 2012-13 influenza season, 46 percent of adults hospitalized with influenza had cardiovascular disease. One study estimates patients with cardiovascular disease are at a three times increased risk of influenza-related hospitalization.

Randomized trials of patients with existing cardiovascular disease show that influenza vaccination decreased the risk of acute coronary syndrome and cardiovascular disease-related deaths. It is also important to note that even modest vaccine effectiveness, such as was seen during the 2012-13 influenza season can have substantial benefits in populations where the burden of disease is high and the outcomes, such as myocardial infarction, are severe.

The research and data cannot be ignored. The ACC, American Heart Association and the Centers for Disease Control and Prevention (CDC) recommend an annual influenza vaccine for secondary prevention of cardiac-related events in persons with coronary and other atherosclerotic vascular disease, including stroke. Yet, despite evidence and recommendations, according to CDC unpublished data, only 48 percent of people 18-64 years with heart disease were vaccinated during the 2012-2013 influenza season.

As a trusted health care professional, research shows that your recommendation for yearly flu vaccination and taking action to get yourself vaccinated is vital. A strong recommendation from you is critical to make sure your patients get vaccinated and to prevent influenza-related cardiovascular disease exacerbations. Effective ways to increase influenza vaccination among people with cardiovascular disease are offering influenza vaccine within your cardiology practice and to having physicians strongly recommend the vaccine to patients.  Outpatient visits to cardiology practices present an excellent, but often missed, opportunity to strongly recommend and provide influenza vaccine.   If you do not offer influenza vaccination, you should refer patients back to their primary care provider or to a pharmacist or local health department to receive the needed vaccines. CDC offers free prescription-style tear-pads that will allow you to give a customized flu shot reminder to patients at high-risk for complications from the flu.  You can use the vaccine finder tool to identify locations offering vaccines in your community.

A number of different influenza vaccine brands are available for the 2013-2014 influenza season. For patients with cardiovascular disease and other chronic medical conditions, any of the inactivated influenza vaccines approved for use for your patient’s age can be used.  However, the live nasal spray vaccine should not be used for patients with cardiovascular disease. Otherwise, there is no preferential recommendation between any type or brand of licensed influenza vaccine over another. Different formulations are available from various manufacturers, so you should refer to the package inserts for the recommended age groups, contraindications and precautions for each vaccine. CDC also offers a complete list of flu vaccines for 2013-14 influenza season.

Use influenza vaccination as an opportunity to remind patients about other recommended vaccines. In addition to influenza vaccine, your patients with cardiovascular disease may also need pneumococcal polysaccharide vaccine which can be given at the same time as influenza vaccine. Your patient may need additional vaccines based on certain considerations, such as the patient’s age.

Remember, you should take an active role in protecting your patients’ health by offering or at least strongly recommending vaccines to them. For more information about adult vaccines, you can visit CDC.gov/Vaccines/AdultPatientEd.

Patient information on the influenza vaccine is available on CardioSmart.org.

Please note that statements or opinions expressed herein reflect the views of the contributor, and do not reflect the official views of the ACCF, unless otherwise noted.

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