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Acute Cardiovascular Events and Influenza in Hospitalized Adults
Quick Takes
- This US population-based cross-sectional study shows a high rate (11.7%) of cardiovascular events in hospitalized patients with influenza.
- Acute heart failure (6.2%) and acute ischemic heart disease (5.7%) were the most common cardiovascular complications in hospitalized patients with influenza.
- Recent vaccination was associated with a lower risk of influenza-related cardiovascular events.
Study Questions:
What is the rate of cardiovascular events in patients hospitalized with laboratory-confirmed influenza?
Methods:
The authors estimated the frequency of cardiovascular events among adults hospitalized with laboratory-confirmed influenza by performing a cross-sectional analysis of data from FluSurv-NET, a large, multicenter US network sponsored by the Centers for Disease Control and Prevention covering 9% of the US population. Patients were included if they had a positive test result for influenza within 14 days before or 3 days after hospital admission. Cardiovascular events were defined using primary and secondary discharge International Classification of Diseases (ICD) codes, restricted to those including acute, acute-on-chronic, or exacerbation, and diagnoses not known to be chronic conditions. The authors classified the acute cardiovascular events into the following seven groups: acute myocarditis, acute pericarditis, acute heart failure (aHF), acute ischemic heart disease (aIHD), cardiac tamponade, cardiogenic shock, and hypertensive crisis.
Results:
A total of 80,261 adult patients (median age of 69 years) hospitalized with confirmed influenza during 2010–2018 were included in the analysis. Close to 12% had an ICD discharge code for an acute cardiovascular event, most commonly aHF (6.2%) or aIHD (5.7%) and less commonly hypertensive crisis (1.0%), cardiogenic shock (0.3%), acute myocarditis (0.1%), acute pericarditis (0.05%), or cardiac tamponade (0.02%). Acute cardiovascular events occurred in 20.6% of those with chronic cardiovascular disease, 19.3% of those with chronic renal disease, and 14.8% of those with diabetes. Age, obesity, prior cardiovascular disease, diabetes, and kidney disease were independently associated with aHF and aIHD. Close to one third of patients with cardiovascular events required intensive care, and 7% died. Risks for aHF (relative risk [RR], 0.86; 95% confidence interval [CI], 0.80-0.92) and aIHD (RR, 0.80; 95% CI, 0.74-0.87) were significantly lower for patients vaccinated against influenza ≥2 weeks before hospitalization than for unvaccinated patients. Patients who received late antiviral treatment had higher risk for aHF and aIHD than those who received early antiviral treatment.
Conclusions:
Almost 12% of hospitalized patients with influenza had an acute cardiovascular event. Risks of aHF and aIHD were lower in patients who had been recently vaccinated.
Perspective:
This population-based study follows a long string of analyses highlighting the high rate of cardiovascular events in patients hospitalized with influenza. Findings are confirmatory and reinforce the importance of influenza prevention through vaccinations and hygienic measures. Yet despite the extensive data supporting the recommendation for influenza vaccination, less than half of US adults received the influenza vaccine in the 2018–2019 season. Cardiovascular specialists should carry the mantle in recommending influenza vaccination at every patient encounter.
Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Pericardial Disease, Prevention, Acute Heart Failure, Hypertension
Keywords: Cardiac Tamponade, Cardiovascular Diseases, Diabetes Mellitus, Heart Failure, Hypertension, Influenza, Human, Kidney Failure, Chronic, Myocardial Ischemia, Myocarditis, Obesity, Patient Discharge, Pericarditis, Primary Prevention, Risk, Shock, Cardiogenic, Vaccination
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