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Vaccination Trends in Heart Failure Patients: GWTG-HF Insights
Study Questions:
What are the contemporary vaccination practice patterns, temporal trends, and factors associated with vaccination in patients with heart failure (HF) in the usual care setting?
Methods:
The investigators evaluated patients hospitalized at centers participating in the Get With The Guidelines–HF (GWTG-HF) registry from October 2012 to March 2017. The proportion of patients receiving vaccination was described for influenza and pneumococcal vaccination, respectively. The association of hospital-level vaccination rates with individual GWTG-HF performance measures and defect-free care was evaluated using multivariable modeling.
Results:
This study evaluated 313,761 patients discharged from 392 hospitals during the study period. The proportion of patients receiving influenza vaccination was 68% overall and declined from 70% in 2012-2013 to 66% in 2016-2017 (p < 0.001), although this was not statistically significant after adjustment (odds ratio, 1.05 per flu season; 95% confidence interval [CI], 0.94-1.18). The proportion of patients receiving pneumococcal vaccination was 66% overall and decreased over the study period from 71% in 2013 to 60% in 2016 (p < 0.001), remaining significant after adjustment (odds ratio, 0.75 per calendar year; 95% CI, 0.67-0.84). Hospitals with higher vaccination rates were more likely to discharge patients with higher performance on defect-free care and individual GWTG-HF performance measures (p < 0.001). In a subset of patients with linked Medicare claims, vaccinated patients had similar rates of 1-year all-cause mortality (adjusted hazard ratio, 0.96 [95% CI, 0.89-1.03] for influenza vaccination; adjusted hazard ratio, 0.95 [95% CI, 0.89-1.01] for pneumococcal vaccination) compared with those not vaccinated.
Conclusions:
The authors concluded that nearly one in three patients hospitalized with HF at participating hospitals were not vaccinated for influenza or pneumococcal pneumonia.
Perspective:
This study reports significant gaps in vaccination use among eligible HF patients, with increasing refusal rates and stagnant to declining vaccination rates over the past 5 years. Furthermore, there are variations and disparities in vaccination use among hospitals, which highlights potential opportunities to improve HF care quality. Of note, hospitals with high performance on influenza and pneumococcal vaccination rates were associated with higher rates of HF achievement or quality measures. Additional studies are needed to develop targeted, systems-level interventions that could improve respiratory vaccination rates and other performance measures for patients with HF, which in turn may improve outcomes.
Clinical Topics: Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure
Keywords: Geriatrics, Heart Failure, Influenza Vaccines, Pneumonia, Primary Prevention, Quality of Health Care, Vaccination
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