The ACC has issued a new Concise Clinical Guidance document, "2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on Adult Immunizations as Part of Cardiovascular Care," recommending immunizations to protect adults with heart disease against respiratory illness, including influenza, COVID-19 and RSV, and other diseases where vaccination is shown to offer cardiovascular protective benefits.

Published in JACC, the CCG consolidates vaccine-specific recommendations made by ACC/American Heart Association guidelines and the U.S. Centers for Disease Control and Prevention (CDC) and includes answers to frequently asked questions. Primary vaccine takeaways include:

1. Influenza – This annual vaccine is recommended for all adults to reduce cardiovascular morbidity, cardiovascular mortality and all-cause death. Nasal versions of the vaccine are not recommended in patients over 50.
2. Pneumococcal – Recommended for adults 19 or older with heart disease, this one-time vaccine protects against pneumonia, bacteremia and meningitis and related risk of hospitalization and death. Following CDC/Advisory Committee on Immunization Practices recommendation, the guidance advises a single dose of PCV20 or PCV21, or PCV15 followed by PPSV23 depending on prior vaccination history.
3. COVID-19 – For the 2024-25 season, all adults with cardiovascular disease were recommended to receive the seasonal COVID-19 vaccine. Future vaccination frequency may change, but it is likely vaccination will remain beneficial for those with cardiovascular disease. Benefits include reduced risk of infection, severe infection, death, myocardial infarction, COVID-19 induced pericarditis/myocarditis, COVID-19 induced stroke and atrial fibrillation, and long COVID symptoms.  
4. RSV – Current guidance recommends a single dose, rather than annual vaccination, for adults 75 or older and for adults aged 50 to 74 with cardiovascular disease to protect against lower respiratory disease that can result in hospitalization and death.
5. Shingles – Recommended for adults 50 or older to receive two doses to protect against increased risk of stroke and myocardial infarction when infected. People with cardiovascular disease are at an increased risk of shingles infection.

In addition to the vaccine-specific guidance, the document outlines strategies to improve vaccination rates, address hesitancy and overcome barriers to access, noting that clinician-patient discussions about vaccination during cardiology visits can be an important opportunity to integrate vaccination into a cardiovascular care plan.

"Access starts with physician knowledge leading to shared decision-making discussions for vaccine administration including how to address vaccine hesitancy," write the authors. "The cardiovascular clinician's effectiveness will be supported by system strategies ... including clinical nudges and clinical 'vaccine champions' to optimize vaccine uptake, reduce morbidity, and ultimately improve patient length and quality of life."

The Frequently Asked Questions section also provides information that can be used to assist with patient discussions. "Vaccination against communicable respiratory diseases and other serious diseases is critical for people with heart disease, but barriers exist to ensuring people are educated on which vaccines to get, how often to get them and why they are important," said Paul A. Heidenreich, MD, FACC, chair of the writing committee. "With this document, we want to encourage clinicians to have these conversations and help their patients manage vaccination as part of a standard prevention and treatment plan."