Eric J Chow1, Melissa A Rolfes1, Alissa O'Halloran1, Evan J Anderson2, Nancy M Bennett3, Laurie Billing4, Shua Chai5, Elizabeth Dufort6, Rachel Herlihy7, Sue Kim8, Ruth Lynfield9, Chelsea McMullen10, Maya L Monroe11, William Schaffner12, Melanie Spencer13, H Keipp Talbot12, Ann Thomas14, Kimberly Yousey-Hindes15, Carrie Reed1, Shikha Garg1. 1. Centers for Disease Control and Prevention, Atlanta, Georgia (E.J.C., M.A.R., A.O., C.R., S.G.). 2. Emory University School of Medicine and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia (E.J.A.). 3. University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B.). 4. Ohio Department of Health, Columbus, Ohio (L.B.). 5. Center for Preparedness and Response, Atlanta, Georgia (S.C.). 6. New York State Department of Health, Albany, New York (E.D.). 7. Colorado Department of Public Health and Environment, Denver, Colorado (R.H.). 8. Michigan Department of Health and Human Services, Lansing, Michigan (S.K.). 9. Minnesota Department of Health, St. Paul, Minnesota (R.L.). 10. New Mexico Department of Health, Santa Fe, New Mexico (C.M.). 11. Maryland Department of Health, Baltimore, Maryland (M.L.M.). 12. Vanderbilt University School of Medicine, Nashville, Tennessee (W.S., H.K.T.). 13. Salt Lake County Health Department, Salt Lake City, Utah (M.S.). 14. Oregon Public Health Division, Portland, Oregon (A.T.). 15. Yale School of Public Health, New Haven, Connecticut (K.Y.).
Abstract
BACKGROUND: Influenza may contribute to the burden of acute cardiovascular events during annual influenza epidemics. OBJECTIVE: To examine acute cardiovascular events and determine risk factors for acute heart failure (aHF) and acute ischemic heart disease (aIHD) in adults with a hospitalization associated with laboratory-confirmed influenza. DESIGN: Cross-sectional study. SETTING: U.S. Influenza Hospitalization Surveillance Network during the 2010-to-2011 through 2017-to-2018 influenza seasons. PARTICIPANTS: Adults hospitalized with laboratory-confirmed influenza and identified through influenza testing ordered by a practitioner. MEASUREMENTS: Acute cardiovascular events were ascertained using discharge codes from the International Classification of Diseases (ICD), Ninth Revision, Clinical Modification, and ICD, 10th Revision. Age, sex, race/ethnicity, tobacco use, chronic conditions, influenza vaccination, influenza antiviral medication, and influenza type or subtype were included as exposures in logistic regression models, and marginal adjusted risk ratios and 95% CIs were estimated to describe factors associated with aHF or aIHD. RESULTS: Among 89 999 adults with laboratory-confirmed influenza, 80 261 had complete medical record abstractions and available ICD codes (median age, 69 years [interquartile range, 54 to 81 years]) and 11.7% had an acute cardiovascular event. The most common such events (non-mutually exclusive) were aHF (6.2%) and aIHD (5.7%). Older age, tobacco use, underlying cardiovascular disease, diabetes, and renal disease were significantly associated with higher risk for aHF and aIHD in adults hospitalized with laboratory-confirmed influenza. LIMITATION: Underdetection of cases was likely because influenza testing was based on practitioner orders. Acute cardiovascular events were identified by ICD discharge codes and may be subject to misclassification bias. CONCLUSION: In this population-based study of adults hospitalized with influenza, almost 12% of patients had an acute cardiovascular event. Clinicians should ensure high rates of influenza vaccination, especially in those with underlying chronic conditions, to protect against acute cardiovascular events associated with influenza. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.
BACKGROUND:Influenza may contribute to the burden of acute cardiovascular events during annual influenza epidemics. OBJECTIVE: To examine acute cardiovascular events and determine risk factors for acute heart failure (aHF) and acute ischemic heart disease (aIHD) in adults with a hospitalization associated with laboratory-confirmed influenza. DESIGN: Cross-sectional study. SETTING: U.S. Influenza Hospitalization Surveillance Network during the 2010-to-2011 through 2017-to-2018 influenza seasons. PARTICIPANTS: Adults hospitalized with laboratory-confirmed influenza and identified through influenza testing ordered by a practitioner. MEASUREMENTS: Acute cardiovascular events were ascertained using discharge codes from the International Classification of Diseases (ICD), Ninth Revision, Clinical Modification, and ICD, 10th Revision. Age, sex, race/ethnicity, tobacco use, chronic conditions, influenza vaccination, influenza antiviral medication, and influenza type or subtype were included as exposures in logistic regression models, and marginal adjusted risk ratios and 95% CIs were estimated to describe factors associated with aHF or aIHD. RESULTS: Among 89 999 adults with laboratory-confirmed influenza, 80 261 had complete medical record abstractions and available ICD codes (median age, 69 years [interquartile range, 54 to 81 years]) and 11.7% had an acute cardiovascular event. The most common such events (non-mutually exclusive) were aHF (6.2%) and aIHD (5.7%). Older age, tobacco use, underlying cardiovascular disease, diabetes, and renal disease were significantly associated with higher risk for aHF and aIHD in adults hospitalized with laboratory-confirmed influenza. LIMITATION: Underdetection of cases was likely because influenza testing was based on practitioner orders. Acute cardiovascular events were identified by ICD discharge codes and may be subject to misclassification bias. CONCLUSION: In this population-based study of adults hospitalized with influenza, almost 12% of patients had an acute cardiovascular event. Clinicians should ensure high rates of influenza vaccination, especially in those with underlying chronic conditions, to protect against acute cardiovascular events associated with influenza. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.
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